Department of Cardiology, The Baker Heart Research Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia.
Department of Cardiology, The Baker Heart Research Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Department of Cardiology, University of Melbourne, Melbourne, Australia.
JACC Clin Electrophysiol. 2020 Dec 14;6(13):1721-1731. doi: 10.1016/j.jacep.2020.08.019. Epub 2020 Oct 28.
This study sought to determine the long-term outcomes of restoring sinus rhythm with catheter ablation (CA).
The CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Heart Failure-An MRI-Guided Multicenter Randomized Controlled Trial) study demonstrated that restoration of sinus rhythm with CA significantly improved left ventricular ejection fraction (LVEF) compared with medical rate control (MRC) at 6 months in persistent atrial fibrillation and otherwise unexplained systolic heart failure. However, the long-term outcomes have not been reported.
Patients enrolled in the CAMERA-MRI study were followed for 4 years with echocardiogram and cardiac magnetic resonance. CA involved pulmonary vein isolation and posterior left atrial wall isolation in 94%. Patients crossed over to CA after 6-month study duration. Arrhythmia burden was determined with implanted cardiac monitors or cardiac devices.
Sixty-six patients (age 62 ± 10 years, atrial fibrillation duration of 22 ± 16 months, and LVEF 33 ± 9%) were randomized 1:1 to CA versus MRC. Eighteen of 33 patients crossed over from MRC group to CA group. At 4.0 ± 0.9 years, atrial fibrillation recurred in 27 patients (57%) in the CA group with a mean burden of 10.6 ± 21.2% after 1.4 ± 0.6 procedures. There was an absolute increase in LVEF with CA of 16.4 ± 13.3% compared with 8.6 ± 7.6% in MRC (p = 0.001). In the CA group, the absence of ventricular late gadolinium enhancement was associated with a greater improvement in absolute LVEF (19 ± 13% vs. 10 ± 11% in the late gadolinium enhancement-positive group; p = 0.04) and LVEF normalization in 19 patients (58%) versus 4 patients (18%) in the late gadolinium enhancement-positive group (p = 0.008) at 4.0 ± 0.9 years follow-up.
CA is superior to MRC in improving LVEF in the long term in patients with atrial fibrillation and systolic heart failure. The greatest recovery in systolic function was demonstrated in the absence of ventricular fibrosis on cardiac magnetic resonance.
本研究旨在确定导管消融（CA）恢复窦性心律的长期疗效。
CAMERA-MRI（导管消融与心房颤动和心力衰竭中的药物心率控制——一项 MRI 指导的多中心随机对照试验）研究表明，与药物心率控制（MRC）相比，在持续性心房颤动和其他不明原因的收缩性心力衰竭患者中，CA 恢复窦性心律可显著改善左心室射血分数（LVEF），在 6 个月时。然而，尚未报道长期结果。
CAMERA-MRI 研究中的患者接受了 4 年的超声心动图和心脏磁共振随访。CA 包括肺静脉隔离和 94%的后左心房壁隔离。患者在研究 6 个月后交叉至 CA 组。通过植入式心脏监测器或心脏设备确定心律失常负担。
66 例患者（年龄 62±10 岁，心房颤动持续时间 22±16 个月，LVEF 33±9%）按 1:1 随机分为 CA 组或 MRC 组。33 例患者中有 18 例从 MRC 组交叉至 CA 组。在 4.0±0.9 年时，CA 组有 27 例（57%）患者出现心房颤动复发，1.4±0.6 次治疗后平均心律失常负担为 10.6±21.2%。与 MRC 组的 8.6±7.6%相比，CA 组的 LVEF 绝对值增加了 16.4±13.3%（p=0.001）。在 CA 组中，心室晚期钆增强的缺失与绝对 LVEF 的更大改善相关（晚期钆增强阳性组为 19±13%，晚期钆增强阴性组为 10±11%；p=0.04），在 4.0±0.9 年的随访中，19 例（58%）患者的 LVEF 正常化，而晚期钆增强阳性组只有 4 例（18%）（p=0.008）。
在心房颤动和收缩性心力衰竭患者中，CA 在长期改善 LVEF 方面优于 MRC。在心脏磁共振上无心室纤维化的患者中，收缩功能的恢复最大。
