Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA.
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA.
Am J Ther. 2019 May/Jun;26(3):e333-e338. doi: 10.1097/MJT.0000000000000931.
Catheter ablation is being increasingly performed for rhythm control of atrial fibrillation (AF). Heart failure (HF) frequently coexists with AF because they share common risk factors.
This study aims at identifying the characteristics and procedural outcomes of patients with HF undergoing catheter ablation of AF.
In this retrospective cohort study, we analyzed 264 consecutive patients who underwent catheter ablation for AF. Seventy-three patients (28%) had a known history of stage C HF either with reduced ejection fraction or preserved ejection fraction.
We compared procedural outcomes between patients who had known HF with those who did not.
Patients with HF were more likely to have higher rates of atrial fibrillation recurrence at both 3 months (odds ratio 2.9, confidence interval = 1.5-5.7, P = 0.0022) and 1 year after the procedure (odds ratio 2.3, confidence interval 1.2-4.3, P = 0.0097) and risk factors for recurrence of AF including left atrial enlargement, persistent AF, and a higher CHA2DS2-VASc score. However, on logistic regression analysis adjusting for left atrial size, atrial fibrillation type (persistent vs. paroxysmal), and CHA2DS2-VASc score as covariates, there was no significant difference in AF recurrence rates at both 3 months and 1 year. Recurrence rates did not differ significantly between patients with HF either with reduced ejection fraction or preserved ejection fraction. Among patients with paroxysmal AF, HF was predictive of AF recurrence at both 3 months and 1 year after ablation. The procedure length was longer in patients with HF, but there were no differences in periprocedural complications.
Patients with HF undergoing catheter ablation of AF tend to have more risk factors for recurrence, but after adjustment for risk factors, the recurrence rates were similar at 3 months and 1 year. Among patients with paroxysmal atrial fibrillation, HF was predictive of higher recurrence rates.
导管消融术在心房颤动（AF）的节律控制中应用越来越广泛。心力衰竭（HF）常与 AF 共存，因为它们有共同的危险因素。
本研究旨在确定接受导管消融治疗 AF 的 HF 患者的特征和程序结果。
在这项回顾性队列研究中，我们分析了 264 例连续接受 AF 导管消融治疗的患者。73 例（28%）有已知的 C 期 HF 病史，射血分数降低或射血分数保留。
我们比较了有和没有已知 HF 的患者的程序结果。
HF 患者在术后 3 个月（优势比 2.9，置信区间 1.5-5.7，P = 0.0022）和 1 年时更有可能出现更高的房颤复发率，以及房颤复发的危险因素，包括左心房增大、持续性房颤和更高的 CHA2DS2-VASc 评分。然而，在调整左心房大小、房颤类型（持续性与阵发性）和 CHA2DS2-VASc 评分作为协变量后，在 3 个月和 1 年时，房颤复发率在逻辑回归分析中没有显著差异。射血分数降低或保留的 HF 患者之间的复发率没有显著差异。在阵发性 AF 患者中，HF 在消融后 3 个月和 1 年均与 AF 复发相关。HF 患者的手术时间较长，但围手术期并发症无差异。
接受导管消融治疗 AF 的 HF 患者复发的危险因素更多，但在调整危险因素后，3 个月和 1 年的复发率相似。在阵发性心房颤动患者中，HF 是复发率较高的预测因素。
