Black-Maier Eric, Steinberg Benjamin A, Trulock Kevin M, Wang Frances, Lokhnygina Yuliya, O'Neal Wanda, Al-Khatib Sana, Atwater Brett D, Daubert James P, Frazier-Mills Camille, Hegland Donald D, Jackson Kevin P, Jackson Larry R, Koontz Jason I, Lewis Robert K, Sun Albert Y, Thomas Kevin L, Bahnson Tristram D, Piccini Jonathan P
Cardiac Electrophysiology Section Duke Center for Atrial Fibrillation Duke University Medical Center Durham NC USA.
Department of Biostatistics Duke University Durham NC USA.
J Arrhythm. 2020 Jan 8;36(1):84-92. doi: 10.1002/joa3.12291. eCollection 2020 Feb.
Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs nonischemic heart failure.
We conducted a retrospective, observational cohort study of patients with HF who underwent AF ablation. Outcomes were compared based on HF etiology and included in-hospital events, symptoms (Mayo AF Symptom Inventory [MAFSI]), and functional status (New York Heart Association class) and freedom from atrial arrhythmias at 12 months.
Among 242 patients (n = 70 [29%] ischemic, n = 172 [71%] nonischemic), patients with nonischemic cardiomyopathy were younger (mean age 64 ± 11.5 vs 69 ± 9.1, = .002), more often female (36% vs 17%, = .004), and had higher mean left-ventricular ejection fraction (47% vs 42%, = .0007). There were no significant differences in periprocedural characteristics, including mean procedure time (243 ± 74.2 vs 259 ± 81.8 minutes, = .1) and nonleft atrial ablation (17% vs 20%, = .6). All-cause adverse events were similar in each group (15% vs 17%, = .7). NYHA and MAFSI scores improved significantly at follow-up and did not differ according to HF etiology ( = .5; = .10-1.00 after Bonferroni correction). There were no significant differences in freedom from recurrent atrial arrhythmia at 12-months between ischemic (74%) and nonischemic patients (78%): adjusted RR 0.63, 95% confidence interval 0.33-1.19.
Catheter ablation in patients with AF and concomitant heart failure leads to significant improvements in functional and symptom status without significant differences between patients with ischemic vs nonischemic HF etiology.
导管消融是伴有心力衰竭（HF）的心房颤动（AF）患者重要的节律控制治疗方法。本研究的目的是评估缺血性心力衰竭与非缺血性心力衰竭的AF消融患者的相对疗效。
我们对接受AF消融的HF患者进行了一项回顾性观察队列研究。根据HF病因比较结局，包括住院事件、症状（梅奥房颤症状量表[MAFSI]）、功能状态（纽约心脏协会分级）以及12个月时无房性心律失常。
在242例患者中（n = 70 [29%]为缺血性，n = 172 [71%]为非缺血性），非缺血性心肌病患者更年轻（平均年龄64±11.5岁对69±9.1岁，P = 0.002），女性更多（36%对17%，P = 0.004），左心室射血分数更高（47%对42%，P = 0.0007）。围手术期特征无显著差异，包括平均手术时间（243±74.2分钟对259±81.8分钟，P = 0.1）和非左心房消融（17%对20%，P = 0.6）。每组的全因不良事件相似（15%对17%，P = 0.7）。随访时纽约心脏协会和MAFSI评分显著改善，且根据HF病因无差异（P = 0.5；经Bonferroni校正后P = 0.10 - 1.00）。缺血性患者（74%）和非缺血性患者（78%）在12个月时无复发性房性心律失常的情况无显著差异：调整后风险比0.63，95%置信区间0.33 - 1.19。
AF合并心力衰竭患者的导管消融可使功能和症状状态显著改善，缺血性与非缺血性HF病因患者之间无显著差异。
