Pallisgaard Jannik Langtved, Lock Hansen Morten, Schjerning Anne-Marie, Johannessen Arne, Gerds Thomas Alexander, Gustafsson Finn, Gislason Gunnar Hilmar, Torp-Pedersen Chriatian, Jacobsen Peter Karl, Kristensen Søren Lund, Koeber Lars, Munch Anders, Schou Morten
Department of Cardiology, Gentofte, Copenhagen University Hospital, Hellerup, Hovedstaden, Denmark
Department of Cardiology, Gentofte, Copenhagen University Hospital, Hellerup, Hovedstaden, Denmark.
Open Heart. 2020 Nov;7(2). doi: 10.1136/openhrt-2020-001369.
Recent randomised clinical trials have suggested prognostic benefits of catheter ablation in highly selected patients with atrial fibrillation (AF) and heart failure (HF).
This study sought to identify the treatment effect associated with catheter ablation in a broad population of patients with AF and HF.
Through nationwide administrative registers in Denmark, we estimated the 2-year average treatment effect (ATE) of catheter ablation for AF on a composite endpoint of HF readmission, stroke and all-cause mortality at 1-year and 5-year landmark analyses. The primary cohort was patients with AF before HF, and the second cohort of patients with HF before AF.
A total of 13 756 patients were included with 9904 patients in the primary cohort, and 3852 in the secondary. An ATE (95% CI) reduction of the composite endpoint of 7.0% (4.5% to 9.5%) was observed in the primary cohort and 11.8% (6.0% to 17.6%) in the secondary in the 1-year landmark analysis with a reduction in all-cause mortality of 5.8% (3.7%-7.8%) and 6.3% (0.9%-11.7%), respectively. At the 5-year landmark, catheter ablation was associated with reductions in the composite endpoint and all-cause mortality in the primary (4.7% (2.3% to 7.2%), and 3.6% (1.0% to 6.3%), respectively), but not in the secondary cohort.
Ablation was associated with decreased risk of HF readmission, stroke and all-cause mortality in patients with AF and HF. The effect is most substantial in patients with AF before HF and with catheter ablation after 1 year from the diagnosis of both conditions.
近期的随机临床试验表明，在经过严格筛选的心房颤动（AF）合并心力衰竭（HF）患者中，导管消融术具有预后益处。
本研究旨在确定在广泛的AF合并HF患者群体中，导管消融术的治疗效果。
通过丹麦全国性行政登记册，我们在1年和5年的标志性分析中，估计了AF导管消融术对HF再入院、中风和全因死亡率复合终点的2年平均治疗效果（ATE）。主要队列是HF发生前患有AF的患者，次要队列是AF发生前患有HF的患者。
共纳入13756例患者，其中主要队列9904例，次要队列3852例。在1年标志性分析中，主要队列中复合终点的ATE（95%CI）降低了7.0%（4.5%至9.5%），次要队列中降低了11.8%（6.0%至17.6%），全因死亡率分别降低了5.8%（3.7%-7.8%）和6.3%（0.9%-11.7%）。在5年标志性分析中，导管消融术与主要队列中复合终点和全因死亡率的降低相关（分别为4.7%（2.3%至7.2%）和3.6%（1.0%至6.3%）），但在次要队列中不相关。
消融术与AF合并HF患者的HF再入院、中风和全因死亡率风险降低相关。在HF发生前患有AF且在两种疾病诊断后1年进行导管消融术的患者中，这种效果最为显著。
