Division of Cardiology, Department of Medicine, Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
Department of Cardiology, Nihon University Hospital, Tokyo, Japan.
Heart Vessels. 2021 Apr;36(4):549-560. doi: 10.1007/s00380-020-01721-x. Epub 2020 Nov 24.
Whether ablation for atrial fibrillation (AF) is, in terms of clinical outcomes, beneficial for Japanese patients has not been clarified. Drawing data from 2 Japanese AF registries (AF Frontier Ablation Registry and SAKURA AF Registry), we compared the incidence of clinically relevant events (CREs), including stroke/transient ischemic attack (TIA), major bleeding, cardiovascular events, and death, between patients who underwent ablation (n = 3451) and those who did not (n = 2930). We also compared propensity-score matched patients (n = 1414 in each group). In propensity-scored patients who underwent ablation and those who did not, mean follow-up times were 27.2 and 35.8 months, respectively. Annualized rates for stroke/TIA (1.04 vs. 1.06%), major bleeding (1.44 vs. 1.20%), cardiovascular events (2.15 vs. 2.49%) were similar (P = 0.96, 0.39, and 0.35, respectively), but annualized death rates were lower in the ablation group than in the non-ablation group (0.75 vs.1.28%, P = 0.028). After multivariate adjustment, the risk of CREs was statistically equivalent between the ablation and non-ablation groups (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.71-1.11), but it was significantly low among patients who underwent ablation for paroxysmal AF (HR 0.68 [vs. persistent AF], 95% CI 0.49-0.94) and had a CHADS-VASc score < 3 (HR 0.66 [vs. CHADS-VASc score ≥ 3], 95% CI 0.43-0.98]). The 2-year risk reduction achieved by ablation may be small among Japanese patients, but AF ablation may benefit those with paroxysmal AF and a CHADS-VASc score < 3.
对于日本患者而言，房颤（AF）消融治疗在临床结局方面是否有益尚未明确。我们从 2 个日本 AF 登记处（AF Frontier Ablation Registry 和 SAKURA AF Registry）提取数据，比较了消融治疗（n=3451）与未行消融治疗（n=2930）患者发生临床相关事件（包括卒中和短暂性脑缺血发作[TIA]、大出血、心血管事件和死亡）的发生率。我们还比较了倾向评分匹配患者（每组 n=1414）。在接受消融治疗和未接受消融治疗的倾向评分匹配患者中，平均随访时间分别为 27.2 和 35.8 个月。卒中和 TIA 的年化发生率（1.04% vs. 1.06%）、大出血的年化发生率（1.44% vs. 1.20%）、心血管事件的年化发生率（2.15% vs. 2.49%）相似（P=0.96、0.39 和 0.35），但消融组的年化死亡率低于未消融组（0.75% vs. 1.28%，P=0.028）。多变量调整后，消融治疗与未消融治疗组发生 CREs 的风险相当（风险比[HR]0.89，95%置信区间[CI]0.71-1.11），但阵发性 AF 患者（HR 0.68[vs.持续性 AF]，95% CI 0.49-0.94）和 CHADS-VASc 评分<3 分（HR 0.66[vs. CHADS-VASc 评分≥3 分]，95% CI 0.43-0.98）患者的风险显著降低。日本患者中，消融治疗带来的 2 年风险降低可能较小，但 AF 消融可能对阵发性 AF 和 CHADS-VASc 评分<3 分的患者有益。
