Foo Fang Shawn, Kerr Andrew, Gabriel Ruvin, Heaven David, Looi Jen-Li, Lund Mayanna, Voss Jamie, Sutton Timothy
Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland.
Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland; University of Auckland, Auckland.
N Z Med J. 2019 Jun 7;132(1496):39-46.
Guidelines recommend initial rate control in haemodynamically stable patients with atrial fibrillation (AF) or atrial flutter (AFL) and acute decompensated heart failure (ADHF). There is limited data on early inpatient rhythm control. We investigated the outcomes of patients managed with early TOE-guided DC cardioversion (DCCV) or ablation.
We retrospectively analysed patients admitted to a single centre with AF or AFL and ADHF with LVEF≤40% that underwent inpatient TOE-guided DCCV or ablation. The primary endpoint was the one year composite outcome of mortality or rehospitalisation for heart failure.
We identified 79 patients, including 33 with AF (32 DCCV, one ablation) and 46 with AFL (22 DCCV, 24 ablation). The primary endpoint occurred in 20%. One-year mortality was 2.5%. There were significantly fewer rehospitalisations for arrhythmia or heart failure with AFL-ablation compared to AFL-DCCV (21% vs 64%, p=<0.01). Clinical recurrence of AF or AFL was 43%. At follow-up LV assessment, LVEF>40% was found in 75% (p=<0.01), including 87% of patients without known cardiomyopathy and 82% of patients in sinus rhythm.
Early inpatient DCCV or ablation for AF or AFL and ADHF had low mortality rates and rehospitalisation for heart failure with substantial improvement in LV function at follow-up.
指南推荐对血流动力学稳定的房颤（AF）或房扑（AFL）合并急性失代偿性心力衰竭（ADHF）患者进行初始心率控制。关于早期住院期间节律控制的数据有限。我们调查了接受早期经食管超声心动图（TOE）引导下直流电复律（DCCV）或消融治疗的患者的结局。
我们回顾性分析了在单一中心住院的AF或AFL合并ADHF且左心室射血分数（LVEF）≤40%并接受住院TOE引导下DCCV或消融治疗的患者。主要终点是死亡或因心力衰竭再次住院的一年复合结局。
我们纳入了79例患者，其中包括33例AF患者（32例行DCCV，1例行消融）和46例AFL患者（22例行DCCV，24例行消融）。主要终点事件发生率为20%。一年死亡率为2.5%。与AFL-DCCV相比，AFL消融术后因心律失常或心力衰竭再次住院的患者明显减少（21%对64%，p<0.01）。AF或AFL的临床复发率为43%。在随访的左心室评估中，75%的患者LVEF>40%（p<0.01），其中包括87%无已知心肌病的患者和82%处于窦性心律的患者。
对于AF或AFL合并ADHF患者，早期住院进行DCCV或消融治疗死亡率低，因心力衰竭再次住院的情况较少，且随访时左心室功能有显著改善。
