心房颤动合并心脏再同步化治疗患者房室结消融：对室性心律失常、植入式心脏复律除颤器治疗和住院的积极影响。
Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations.
机构信息
Electrophysiology and Pacing Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy.
Department of Cardiology, Ruhr-Universität-Bochum, Bochum, Germany.
出版信息
Eur J Heart Fail. 2018 Oct;20(10):1472-1481. doi: 10.1002/ejhf.1117. Epub 2017 Dec 18.
AIMS
We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs.
METHODS AND RESULTS
This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6 years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF + AVJA) and 402 (12%) treated with rate-slowing drugs (AF + Drugs). Median follow-up was 18 months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF + AVJA, 43.6 (37.7-50.4) in AF + Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF + AVJA vs. AF + Drugs (P < 0.001) and 0.48 (0.35-0.66) for AF + AVJA vs. SR (P < 0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P < 0.001, vs. AF + Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P < 0.001, vs. AF + Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF + AVJA vs. AF + Drugs [IRR 0.57 (0.41-0.79), P < 0.001] and SR [IRR 0.85 (073-0.98), P = 0.027].
CONCLUSION
In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.
CLINICAL TRIAL REGISTRATION
NCT00147290, NCT00617175, NCT01007474.
目的
我们旨在确定在接受心脏再同步治疗（CRT）植入式心脏复律除颤器（ICD）且伴有永久性房颤（AF）的患者中，房室结消融（AVJA）与减慢心率药物相比是否对 ICD 电击和住院治疗有积极影响。
方法和结果
这是来自参与两项随机试验和一项前瞻性观察性研究的 179 个国际中心的数据的汇总分析。主要终点是全因 ICD 电击和全因住院。在 3358 例 CRT-ICD 患者（2720 名男性，66.6 岁）中，2694 例（80%）处于窦性心律（SR），664 例（20%）为永久性 AF-262（8%）接受 AVJA（AF+AVJA）治疗，402 例（12%）接受减慢心率药物（AF+药物）治疗。中位随访时间为 18 个月。每 100 名患者年的全因 ICD 电击的平均（95%置信区间）年发生率分别为 AF+AVJA 组 8.0（5.3-11.9），AF+药物组 43.6（37.7-50.4），SR 组 34.4（32.5-36.5），AF+AVJA 组与 AF+药物组相比，发生率比（IRR）降低 0.18（0.10-0.32）（P<0.001），与 SR 组相比，IRR 降低 0.48（0.35-0.66）（P<0.001）。这些减少是由适当的 ICD 电击[IRR 0.23（0.13-0.40），P<0.001，与 AF+药物组相比]和不适当的 ICD 电击[IRR 0.09（0.04-0.21），P<0.001，与 AF+药物组相比]的显著减少所致。与 AF+药物组相比，AF+AVJA 组的全因住院率[IRR 0.57（0.41-0.79），P<0.001]和 SR 组[IRR 0.85（0.73-0.98），P=0.027]明显降低。
结论
在接受 CRT 治疗的 AF 患者中，AVJA 可降低全因、适当和不适当 ICD 电击的发生率和负担，以及全因和心力衰竭住院的发生率。
临床试验注册
NCT00147290，NCT00617175，NCT01007474。
Zotero 插件