Saksena Sanjeev, Slee April, Saad Marwan
Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA.
Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA.
J Interv Card Electrophysiol. 2018 Oct;53(1):9-17. doi: 10.1007/s10840-018-0408-1. Epub 2018 Jul 9.
We examined the long-term (≥ 5 years) outcomes of dual-site atrial pacing (DAP) when added to background antiarrhythmic drugs (AADs) and/or ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF).
Seventy-three patients with HF (mean NYHA HF class of 2.5) and AF refractory to AADs and/or ablation were implanted with DAP systems to achieve biatrial electrical and mechanical resynchronization (ART) and rhythm control (RC).
Thirty-eight patients with refractory AF and HF with preserved ejection fraction (HFpEF) and 35 with reduced ejection fraction (HFrEF) were enrolled. HFpEF patients had higher left ventricular ejection fraction compared to HFrEF (53 ± 5 vs. 31 ± 10% p < 0.001). Median follow-up for survival was 9.3 years (mean 9.0 years, SE 0.63) and was similar across subgroups (p = 0.127). After DAP, 87% maintained RC with improvement in NYHA HF class (mean 1.8) at 3 years. RC was similar in HFpEF compared with HFrEF patients (89 vs. 85% respectively, p = NS) and in paroxysmal versus persistent AF (90 vs. 85% respectively, p = NS). Total survival was superior in HFpEF compared HFrEF patients (75% in HFpEF vs. 45% in HFrEF at 5 years, and 60% in HFpEF vs. 34% in HFrEF at 10 years, p = 0.036). Survival trended to be better in patients with RC than those without RC (75 vs. 54% respectively at 5 years, p = .13).
ART using DAP as add on therapy improved HF and established long-term RC in many patients with HFrEF and HFpEF with refractory AF. Long-term survival rates were superior in HFpEF than HFrEF.
我们研究了在难治性心房颤动（AF）和心力衰竭（HF）患者中，在背景抗心律失常药物（AADs）和/或消融基础上添加双部位心房起搏（DAP）的长期（≥5年）结局。
73例HF患者（纽约心脏协会HF分级平均为2.5级）且对AADs和/或消融难治的AF患者植入DAP系统，以实现双房电和机械再同步化（ART）及节律控制（RC）。
纳入38例射血分数保留的难治性AF和HF患者（HFpEF）以及35例射血分数降低的患者（HFrEF）。与HFrEF患者相比，HFpEF患者的左心室射血分数更高（53±5 vs. 31±10%，p<0.001）。生存的中位随访时间为9.3年（平均9.0年，标准误0.63），各亚组相似（p=0.127）。DAP治疗后，87%的患者在3年时维持RC，纽约心脏协会HF分级有所改善（平均改善1.8级）。HFpEF患者与HFrEF患者的RC相似（分别为89%和85%，p=无显著差异），阵发性AF与持续性AF患者的RC也相似（分别为90%和85%，p=无显著差异）。HFpEF患者的总生存率高于HFrEF患者（5年时HFpEF为75%，HFrEF为45%；10年时HFpEF为60%，HFrEF为34%，p=0.036）。有RC的患者生存率趋势优于无RC的患者（5年时分别为75%和54%，p=0.13）。
使用DAP作为附加治疗的ART改善了HF，并在许多HFrEF和HFpEF合并难治性AF的患者中建立了长期RC。HFpEF患者的长期生存率高于HFrEF患者。
