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心力衰竭射血分数保留与降低患者心房颤动消融术后结局比较。

Comparison of Outcomes After Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Versus Reduced Ejection Fraction.

机构信息

Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California.

Division of Cardiac Electrophysiology at the University of California San Diego Health System, La Jolla, California.

出版信息

Am J Cardiol. 2020 Dec 1;136:62-70. doi: 10.1016/j.amjcard.2020.09.018. Epub 2020 Sep 15.

Abstract

Catheter ablation improves outcomes in atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). We sought to evaluate the efficacy and safety of catheter ablation of AF in HF patients with a preserved ejection fraction (HFpEF). We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was recurrence of all atrial arrhythmias on or off antiarrhythmic drugs (AAD). Of 547 total patients, 51 (9.3%) had HFpEF, 40 (7.3%) had HFrEF, and 456 (83.4%) were without HF. There was no difference in recurrence of atrial arrhythmias on or off AAD (Adjusted Hazard Ratio [AHR] 1.92 [95% CI 0.97 to 3.83] for HFpEF vs HFrEF and AHR 0.90 [95% CI 0.59 to 1.39] for HFpEF vs no HF) or off AAD (AHR 1.96 [95% CI 0.99 to 3.90] for HFpEF vs HFrEF and AHR 1.14 [95% CI 0.74 to 1.77] for HFpEF vs no HF). There was also no difference in rates of all-cause hospitalizations (AHR 1.80 [95% CI 0.97 to 3.33] for HFpEF vs HFrEF and AHR 2.05 [95% CI 1.30 to 3.23] for HFpEF vs no HF) or rates of all-cause mortality (AHR 0.53 [95% CI 0.05 to 6.11] for HFpEF vs HFrEF and AHR 2.46 [95% CI 0.34 to 17.92] for HFpEF vs no HF). There were no significant differences in AAD use (p = 0.176) or procedural complications between groups (p = 0.980). In conclusion, there were no significant differences in arrhythmia-free survival between patients with HFpEF and HFrEF that underwent catheter ablation of AF.

摘要

导管消融可改善射血分数降低的心力衰竭(HFrEF)合并心房颤动(AF)患者的结局。我们旨在评估保留射血分数的心力衰竭(HFpEF)患者行导管消融 AF 的疗效和安全性。我们对所有在加利福尼亚大学圣地亚哥房颤消融注册中心接受新的射频导管消融的患者进行了回顾性研究。主要结果是停用或不停用抗心律失常药物(AAD)时所有房性心律失常的复发。在 547 例患者中,51 例(9.3%)为 HFpEF,40 例(7.3%)为 HFrEF,456 例(83.4%)为非 HF。停用或不停用 AAD 时房性心律失常的复发无差异(HFpEF 与 HFrEF 的调整后的危险比 [AHR] 为 1.92 [95% CI 0.97 至 3.83],HFpEF 与非 HF 的 AHR 为 0.90 [95% CI 0.59 至 1.39])或停用 AAD 时房性心律失常的复发无差异(HFpEF 与 HFrEF 的 AHR 为 1.96 [95% CI 0.99 至 3.90],HFpEF 与非 HF 的 AHR 为 1.14 [95% CI 0.74 至 1.77])。全因住院率(HFpEF 与 HFrEF 的 AHR 为 1.80 [95% CI 0.97 至 3.33],HFpEF 与非 HF 的 AHR 为 2.05 [95% CI 1.30 至 3.23])或全因死亡率(HFpEF 与 HFrEF 的 AHR 为 0.53 [95% CI 0.05 至 6.11],HFpEF 与非 HF 的 AHR 为 2.46 [95% CI 0.34 至 17.92])也无差异。各组之间 AAD 使用(p = 0.176)或手术并发症(p = 0.980)无显著差异。总之,HFpEF 与 HFrEF 患者行导管消融 AF 后,心律失常无复发率无显著差异。

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