Agasthi Pradyumna, Lee Justin Z, Amin Mustapha, Al-Saffar Farah, Goel Vasudha, Tseng Andrew, Almader-Douglas Diana, Killu Ammar M, Deshmukh Abhishek J, Del-Carpio Munoz Freddy, Mulpuru Siva K
Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix Arizona.
Department of Cardiovascular Diseases Mayo Clinic Rochester Rochester Minnesota.
J Arrhythm. 2019 Jan 17;35(2):171-181. doi: 10.1002/joa3.12146. eCollection 2019 Apr.
Atrial fibrillation (AF) among patients with heart failure with reduced ejection fraction (HFrEF) is associated with adverse clinical outcomes. Our primary aim was to evaluate patient-centered outcomes and surrogate outcomes following catheter ablation (CA) of AF among patients with HFrEF compared to standard medical therapy with or without device therapy (atrioventricular node ablation and cardiac resynchronization therapy).
A systematic literature review was performed limiting our searches to randomized control trials reporting outcomes of CA compared to standard medical therapy with or without device therapy were included. Patient-centered outcomes were relative reduction in all-cause mortality, heart failure readmissions, and recurrence of AF. Surrogate outcomes of interest were change in ejection fraction, change in peak oxygen consumption, reduction in brain natriuretic peptide levels, change in 6-minute walk distance, and change in Minnesota living with heart failure score.
Seven randomized control trials (Patient n = 721) met our inclusion criteria. All trials used radiofrequency energy for CA of AF. CA for AF was associated with significantly lower all-cause mortality (Risk ratio [RR] = 0.52, 95% confidence interval [CI] = 0.35-0.76, = 0.001, = 0%), lower rate of heart failure readmission (RR = 0.58, 95% CI = 0.46-0.74, < 0.001, = 0%) and lower rate of AF recurrence (RR = 0.33, 95% CI = 0.22-0.50, < 0.001, = 68%) as compared to standard medical therapy. Surrogate outcomes showed a similar benefit favoring CA.
Catheter ablation for AF in HFrEF is associated with improvement in patient-centered outcomes and surrogate outcomes when compared to standard medical therapy with or without device therapy.
射血分数降低的心力衰竭（HFrEF）患者发生心房颤动（AF）与不良临床结局相关。我们的主要目的是评估HFrEF患者接受房颤导管消融（CA）治疗与接受有或无器械治疗（房室结消融和心脏再同步治疗）的标准药物治疗相比，以患者为中心的结局和替代结局。
进行了一项系统的文献综述，将搜索范围限制在报告CA与有或无器械治疗的标准药物治疗相比的结局的随机对照试验。以患者为中心的结局是全因死亡率、心力衰竭再入院率和房颤复发率的相对降低。感兴趣的替代结局是射血分数的变化、峰值耗氧量的变化、脑钠肽水平的降低、6分钟步行距离的变化以及明尼苏达心力衰竭生活评分的变化。
七项随机对照试验（患者n = 721）符合我们的纳入标准。所有试验均使用射频能量进行房颤的CA。与标准药物治疗相比，房颤的CA与显著更低的全因死亡率（风险比[RR]=0.52，95%置信区间[CI]=0.35-0.76，P = 0.001，I² = 0%）、更低的心力衰竭再入院率（RR = 0.58，95%CI = 0.46-0.74，P < 0.001，I² = 0%）和更低的房颤复发率（RR = 0.33，95%CI = 0.22-0.50，P < 0.001，I² = 68%）相关。替代结局显示CA有类似的益处。
与有或无器械治疗的标准药物治疗相比，HFrEF患者的房颤导管消融与以患者为中心的结局和替代结局的改善相关。
