Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego Health System, La Jolla, California.
Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Diego Health System, La Jolla, California.
Am J Cardiol. 2021 Mar 1;142:66-73. doi: 10.1016/j.amjcard.2020.11.039. Epub 2020 Dec 5.
Catheter ablation improves clinical outcomes in atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF with a preserved ejection fraction (HFpEF) is less clear. We performed a literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR; where a RR <1.0 favors the HFpEF group) and mean difference (MD; where MD <0 favors the HFpEF group) 95% confidence intervals (CI) were measured for dichotomous and continuous variables, respectively. Six studies with a total of 1,505 patients were included, of which 764 (51%) had HFpEF and 741 (49%) had HFrEF. Patients with HFpEF experienced similar recurrence of AF 1 year after ablation on or off antiarrhythmic drugs compared with those with HFrEF (RR 1.01; 95% CI 0.76, 1.35). Fluoroscopy time was significantly shorter in the HFpEF group (MD -5.42; 95% CI -8.51, -2.34), but there was no significant difference in procedure time (MD 1.74; 95% CI -11.89, 15.37) or periprocedural adverse events between groups (RR 0.84; 95% CI 0.54,1.32). There was no significant difference in hospitalizations between groups (MD 1.18; 95% CI 0.90, 1.55), but HFpEF patients experienced significantly less mortality (MD 0.41; 95% CI 0.18, 0.94). In conclusion, based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as safe and efficacious in maintaining sinus rhythm as in those with HFrEF.
导管消融术可改善射血分数降低的心力衰竭（HFrEF）合并心房颤动（AF）患者的临床预后。然而，导管消融术在射血分数保留的心力衰竭（HFpEF）患者中的作用尚不清楚。我们进行了文献检索和系统评价，比较了 HFpEF 与 HFrEF 患者在接受 AF 导管消融术后 1 年时 AF 复发的情况。分别测量二分类变量和连续变量的风险比（RR；RR<1.0 有利于 HFpEF 组）和均数差值（MD；MD<0 有利于 HFpEF 组）95%置信区间（CI）。纳入 6 项共 1505 例患者的研究，其中 764 例（51%）为 HFpEF，741 例（49%）为 HFrEF。接受 AF 导管消融术的 HFpEF 患者在服用或不服用抗心律失常药物后 1 年时的 AF 复发率与 HFrEF 患者相似（RR 1.01；95%CI 0.76，1.35）。HFpEF 组透视时间明显缩短（MD-5.42；95%CI-8.51，-2.34），但两组手术时间（MD 1.74；95%CI-11.89，15.37）或围手术期不良事件（RR 0.84；95%CI 0.54，1.32）无显著差异。两组住院率无显著差异（MD 1.18；95%CI 0.90，1.55），但 HFpEF 患者的死亡率明显较低（MD 0.41；95%CI 0.18，0.94）。总之，基于这项荟萃分析的结果，HFpEF 合并 AF 患者的导管消融术在维持窦性心律方面似乎与 HFrEF 患者一样安全有效。
