Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan university, Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China.
Department of Cardiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China.
Europace. 2021 May 21;23(5):731-739. doi: 10.1093/europace/euaa356.
The roles of radiofrequency catheter ablation (RFCA) and pharmacotherapy in treating persistent and long-standing persistent atrial fibrillation (AF) have not been sufficiently investigated. We conducted a multicentre, randomized, controlled trial to compare the effects of RFCA and pharmacotherapy on the prognosis of these patients.
A total of 648 patients with persistent and long-standing persistent AF were enrolled from 30 centres and randomized to either the ablation group (n = 327) or the pharmacotherapy group (n = 321). After 54.2 ± 10.6 months of follow-up, the primary endpoints occurred significantly more rarely in the ablation group than in the pharmacotherapy group (10.4% vs. 17.4%; hazard ratio 0.59, 95% confidence interval 0.48-0.75; P < 0.001). The incidence of stroke/transient ischaemic attack (TIA) was significantly lower in the ablation group (4.2% vs. 7.2%, P < 0.001). Likewise, the incidence of new-onset congestive heart failure (CHF) was lower in the ablation group (2.8% vs. 7.2%, P < 0.001). More patients had sinus rhythm in the ablation group than in the pharmacotherapy group (60.6% vs. 20.9%, P < 0.001), but fewer patients were on antiarrhythmic drugs (24.4% vs. 41.6%, P < 0.001) and warfarin (60.8% vs. 83.9%, P = 0.001). Both the 6-min walk distance and the quality of life (QoL) were improved in the ablation group at the end of follow-up.
In patients with persistent and long-standing persistent AF, RFCA-based treatment was superior to pharmacotherapy in decreasing stroke/TIA and new-onset CHF and improving QoL.
射频导管消融（RFCA）和药物治疗在治疗持续性和长期持续性心房颤动（AF）中的作用尚未得到充分研究。我们进行了一项多中心、随机、对照试验，比较 RFCA 和药物治疗对这些患者预后的影响。
共纳入 30 个中心的 648 例持续性和长期持续性 AF 患者，并随机分为消融组（n=327）或药物治疗组（n=321）。随访 54.2±10.6 个月后，消融组主要终点事件发生率明显低于药物治疗组（10.4%比 17.4%；风险比 0.59，95%置信区间 0.48-0.75；P<0.001）。消融组卒中/短暂性脑缺血发作（TIA）发生率明显低于药物治疗组（4.2%比 7.2%，P<0.001）。同样，消融组新发充血性心力衰竭（CHF）发生率也低于药物治疗组（2.8%比 7.2%，P<0.001）。消融组窦性心律患者多于药物治疗组（60.6%比 20.9%，P<0.001），但抗心律失常药物（24.4%比 41.6%，P<0.001）和华法林（60.8%比 83.9%，P=0.001）的使用率较低。随访结束时，消融组 6 分钟步行距离和生活质量（QoL）均得到改善。
在持续性和长期持续性 AF 患者中，基于 RFCA 的治疗在降低卒中/TIA 和新发 CHF 发生率以及改善 QoL 方面优于药物治疗。
