房颤导管消融对心力衰竭患者长期临床结局的影响。
Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure.
机构信息
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Department of Cardiovascular Medicine, Fukui University, Fukui, Japan.
出版信息
J Cardiol. 2018 Sep;72(3):240-246. doi: 10.1016/j.jjcc.2018.02.012. Epub 2018 Mar 30.
BACKGROUND
Heart failure (HF) promotes atrial fibrillation (AF) and AF worsens HF. This study aimed to investigate the long-term clinical outcomes after AF ablation in patients with HF.
METHODS AND RESULTS
A total of 106 consecutive HF patients, including 51 (48.1%) with a reduced left ventricular ejection fraction (LVEF) (HFrEF) and 55 (51.9%) with a preserved LVEF (HFpEF), underwent AF ablation. All patients underwent successful pulmonary vein antrum isolation, and substrate modification was added in 38 (35.8%). The mean follow-up period was 32.4±18.6 months, and mean number of procedures was 1.4±0.5 per patient. Low-dose antiarrhythmic drugs were combined in 29 (27.3%) patients. Freedom from recurrent atrial arrhythmias (ATa), HF-related hospitalizations, and the composite endpoint (all-cause death, stroke, HF-related hospitalizations) at 3 years was 88.7%, 97.6%, and 97.6% in HFrEF patients, and 79.3%, 96.2%, and 91.8% in HFpEF patients, respectively. LVEF normalization (≥50%) was observed in 37 (72.5%) HFrEF patients post-ablation, and a smaller LV diastolic diameter (LVDd) was the sole predictor [odds ratio (OR)=0.863; 95% confidence interval (CI)=0.779-0.955, p=0.005]. Shortening of the LVDd (≥5mm) was observed in 16 (29.1%) HFpEF patients post-ablation, and no recurrence after the initial procedure was the sole predictor (OR=6.229; 95% CI=1.524-25.469, p=0.011).
CONCLUSIONS
Catheter ablation of AF could be one of the important therapeutic options in the management of patients with HF combined with AF regardless of the type of HF.
背景
心力衰竭（HF）可促进心房颤动（AF），而 AF 可使 HF 恶化。本研究旨在探讨 HF 患者 AF 消融后的长期临床结局。
方法和结果
共纳入 106 例连续 HF 患者，其中 51 例（48.1%）左心室射血分数（LVEF）降低（HFrEF），55 例（51.9%）LVEF 保留（HFpEF），所有患者均成功进行了肺静脉电隔离，38 例（35.8%）患者进行了基质改良。平均随访时间为 32.4±18.6 个月，平均每位患者行 1.4±0.5 次手术。29 例（27.3%）患者联合使用低剂量抗心律失常药物。HFrEF 患者 3 年时无复发性房性心律失常（ATa）、HF 相关住院和复合终点（全因死亡、卒中和 HF 相关住院）的比例分别为 88.7%、97.6%和 97.6%，HFpEF 患者分别为 79.3%、96.2%和 91.8%。消融后 37 例（72.5%）HFrEF 患者 LVEF 恢复正常（≥50%），LVDd 减小（≤40mm）是唯一的预测因素[比值比（OR）=0.863；95%置信区间（CI）=0.779-0.955，p=0.005]。消融后 16 例（29.1%）HFpEF 患者 LVDd 缩短（≥5mm），首次手术无复发是唯一的预测因素（OR=6.229；95%CI=1.524-25.469，p=0.011）。
结论
导管消融 AF 可能是 HF 合并 AF 患者治疗的重要选择之一，无论 HF 类型如何。
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