Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
J Cardiovasc Electrophysiol. 2019 Nov;30(11):2310-2318. doi: 10.1111/jce.14144. Epub 2019 Sep 22.
The presence of heart failure (HF) has been associated with poorer outcomes in patients undergoing catheter ablation (CA) for atrial fibrillation (AF). However, the effectiveness of CA amongst the subset of patients with tachycardia-induced cardiomyopathy (TIC) remains poorly defined.
In a retrospective analysis we compared outcomes of first-time CA for persistent AF in a cohort of patients with previously diagnosed TIC (n = 45; age 58 ± 8 years; 91% male) to those with structurally normal hearts (non-TIC; n = 440; age 55 ± 9 years; 95% male). TIC was defined as an impaired ventricular function (left ventricular ejection function [LVEF] <50%), which was reversed after the treatment of HF. We compared atrial arrhythmias (AAs) recurrence after the CA in the TIC and non-TIC cohorts. In the TIC group, LVEF improved from 35.8% ± 8.1% to 57.5% ± 8.3% after treatment of HF. During 3.3 ± 1.5 years follow-up, AAs-free survival after CA was significantly higher in the TIC group as compared with the non-TIC group (69% vs 42%; P = .001), despite a comparable CA strategy between the two groups. In multivariable analysis, absence of HF with TIC, longer AF duration, and complex fractionated atrial electrogram ablation were independent predictors of arrhythmia recurrence (OR, 1.02; 95% CI, 1.01-1.03; P < .01; OR, 0.40; 95% CI, 0.20-0.79; P < .01 and OR, 2.29; 95%CI; 1.27-4.11; P < .01, respectively). In addition, the outcome after the last procedure was superior in the TIC cohort (89% vs 72%; P = .03) with fewer CA procedures as compared with the non-TIC cohort (1.3 ± 0.5 vs 1.5 ± 0.7; P = .01).
Persistent patients with AF with TIC have a more favorable outcome after the CA as compared with those without.
心力衰竭（HF）的存在与接受导管消融（CA）治疗心房颤动（AF）的患者的预后较差有关。然而，在心动过速性心肌病（TIC）患者亚组中，CA 的有效性仍未得到明确界定。
在一项回顾性分析中，我们比较了一组先前诊断为 TIC（n=45；年龄 58±8 岁；91%为男性）和一组结构正常心脏（非-TIC；n=440；年龄 55±9 岁；95%为男性）的持续性 AF 患者首次 CA 的结果。TIC 的定义为心室功能受损（左心室射血分数[LVEF] <50%），HF 治疗后可逆转。我们比较了 TIC 和非-TIC 两组患者 CA 后的房性心律失常（AA）复发情况。在 TIC 组中，HF 治疗后 LVEF 从 35.8%±8.1%提高至 57.5%±8.3%。在 3.3±1.5 年的随访期间，与非-TIC 组相比，TIC 组 CA 后的 AA 无复发生存率显著更高（69% vs 42%；P=0.001），尽管两组之间的 CA 策略相当。多变量分析显示，TIC 无 HF、AF 持续时间较长和复杂碎裂心房电图消融是心律失常复发的独立预测因素（OR，1.02；95%CI，1.01-1.03；P<.01；OR，0.40；95%CI，0.20-0.79；P<.01 和 OR，2.29；95%CI；1.27-4.11；P<.01）。此外，与非-TIC 组相比，TIC 组的最后一次手术结果更好（89% vs 72%；P=0.03），CA 手术次数也更少（1.3±0.5 vs 1.5±0.7；P=0.01）。
与无 TIC 的患者相比，持续性 AF 合并 TIC 的患者在 CA 后有更好的预后。
