Division of Cardiology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2019 Jan 11;14(1):e0210603. doi: 10.1371/journal.pone.0210603. eCollection 2019.
It remains unclear as to whether cardiac resynchronization therapy (CRT) would be as effective in patients with atrial fibrillation (AF) accompanied by slow ventricular response (AF-SVR, < 60 beats/min) as in those with sinus rhythm (SR). Echocardiographic reverse remodeling was compared between AF-SVR patients (n = 17) and those with SR (n = 88) at six months and 12 months after CRT treatment. We also evaluated the changes in QRS duration; New York Heart Association (NYHA) functional class; and long-term composite clinical outcomes including cardiac death, heart transplantation, and heart failure (HF)-related hospitalization. Left ventricular pacing sites and biventricular pacing percentages were not significantly different between the AF-SVR and SR groups. However, heart rate increase after CRT was significantly greater in the AF-SVR group than in the SR group (P < 0.001). At six and 12 months postoperation, both groups showed a comparable improvement in NYHA class; QRS narrowing; and echocardiographic variables including left ventricular end-systolic volume, left ventricular ejection fraction, and left atrial volume index. Over the median follow-up duration of 1.6 (interquartile range: 0.8-2.2) years, no significant between-group differences were observed regarding the rates of long-term composite clinical events (35% versus 24%; hazard ratio: 1.71; 95% confidence interval: 0.23-12.48; P = 0.60). CRT implantation provided comparable beneficial effects for patients with AF-SVR as compared with those with SR, by correcting electrical dyssynchrony and increasing biventricular pacing rate, in terms of QRS narrowing, symptom improvement, ventricular reverse remodeling, and long-term clinical outcomes.
对于伴有缓慢心室反应（AF-SVR，<60 次/分）的心房颤动（AF）患者，心脏再同步治疗（CRT）是否与窦性节律（SR）患者同样有效尚不清楚。在 CRT 治疗后 6 个月和 12 个月，比较了 AF-SVR 患者（n=17）和 SR 患者（n=88）的超声心动图逆重构情况。我们还评估了 QRS 时限的变化；纽约心脏协会（NYHA）功能分级；以及包括心脏死亡、心脏移植和心力衰竭（HF）相关住院治疗在内的长期复合临床结局。AF-SVR 组和 SR 组的左心室起搏部位和双心室起搏比例无显著差异。然而，CRT 后心率增加在 AF-SVR 组显著大于 SR 组（P<0.001）。术后 6 个月和 12 个月，两组 NYHA 分级、QRS 变窄以及超声心动图变量（包括左室收缩末期容积、左室射血分数和左心房容积指数）均有类似改善。在中位数为 1.6 年（四分位距：0.8-2.2）的中位随访期间，长期复合临床结局发生率在两组之间无显著差异（35%与 24%；危险比：1.71；95%置信区间：0.23-12.48；P=0.60）。CRT 植入通过纠正电不同步和增加双心室起搏率，为 AF-SVR 患者提供了与 SR 患者相当的有益效果，表现在 QRS 变窄、症状改善、心室逆重构和长期临床结局方面。
