Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany (C.S.).
Department of Cardiology, Klinikum Coburg, Germany (K.Z., C.M., J.B.).
Circ Arrhythm Electrophysiol. 2020 Oct;13(10):e008461. doi: 10.1161/CIRCEP.120.008461. Epub 2020 Sep 9.
Recent data demonstrate promising effects on left ventricular dysfunction and left ventricular ejection fraction (LVEF) improvement following ablation for atrial fibrillation (AF) in patients with heart failure. We sought to study the relationship between LVEF, New York Heart Association class on presentation, and the end points of mortality and heart failure admissions in the CASTLE-AF study (Catheter Ablation for Atrial Fibrillation With Heart Failure) population. Furthermore, predictors for LVEF improvement were examined.
The CASTLE-AF patients with coexisting heart failure and AF (n=363) were randomized in a multicenter prospective controlled fashion to ablation (n=179) versus pharmacological therapy (n=184). Left ventricular function and New York Heart Association class were assessed at baseline (after randomization) and at each follow-up visit.
In the ablation arm, a significantly higher number of patients experienced an improvement in their LVEF to >35% at the end of the study (odds ratio, 2.17; <0.001). Compared with the pharmacological therapy arm, both ablation patient groups with severe (<20%) or moderate/severe (≥20% and <35%) baseline LVEF had a significantly lower number of composite end points (hazard ratio [HR], 0.60; =0.006), all-cause mortality (HR, 0.54; =0.019), and cardiovascular hospitalizations (HR, 0.66; =0.017). In the ablation group, New York Heart Association I/II patients at the time of treatment had the strongest improvement in clinical outcomes (primary end point: HR, 0.43; <0.001; mortality: HR, 0.30; =0.001).
Compared with pharmacological treatment, AF ablation was associated with a significant improvement in LVEF, independent from the severity of left ventricular dysfunction. AF ablation should be performed at early stages of the patient's heart failure symptoms.
最近的数据表明，对于心力衰竭合并心房颤动（AF）的患者，消融治疗在改善左心室功能和左心室射血分数（LVEF）方面有积极作用。我们旨在研究 CASTLE-AF 研究（心力衰竭合并心房颤动的导管消融）人群中 LVEF、就诊时纽约心脏协会（NYHA）心功能分级与死亡率和心力衰竭住院终点之间的关系。此外，还研究了 LVEF 改善的预测因素。
CASTLE-AF 研究中，363 例心力衰竭合并 AF 的患者被随机分为消融（n=179）组和药物治疗（n=184）组。在基线（随机分组后）和每次随访时评估左心室功能和 NYHA 心功能分级。
在消融组中，研究结束时 LVEF ＞35%的患者比例显著增加（优势比，2.17；＜0.001）。与药物治疗组相比，基线 LVEF 严重（＜20%）或中度/严重（≥20%和＜35%）的两组消融患者的复合终点（全因死亡率、心血管住院率）数量均显著减少（风险比，0.60；=0.006）。在消融组中，治疗时 NYHA I/II 级的患者临床结局改善最强（主要终点：风险比，0.43；＜0.001；死亡率：风险比，0.30；=0.001）。
与药物治疗相比，AF 消融与 LVEF 的显著改善相关，与左心室功能障碍的严重程度无关。AF 消融应在患者心力衰竭症状的早期进行。
