Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.
Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.
Rev Port Cardiol (Engl Ed). 2021 Feb;40(2):95-103. doi: 10.1016/j.repc.2020.05.016. Epub 2021 Jan 6.
In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed.
To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events.
We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center.
A total of 123 patients, mean age 69±9 years and 52% male, underwent AV node ablation. Most of them presented atrial fibrillation at baseline (65%). During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF) functional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98±1.3 versus 0.28±0.8, p=0.001) and emergency department (ED) visits (1.1±1 versus 0.17±0.7, p=0.0001). There were no device-related complications. Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47±13% vs. 47%±12, p=0.63). Twenty-eight patients died (23%). The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002).
Despite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia.
在室上性心律失常且心室率高的患者中，对心率和节律控制治疗或导管消融无反应时，可能会进行房室（AV）结消融。
评估 AV 结消融后的长期结果，并分析不良事件的预测因素。
我们对 1997 年 2 月至 2019 年 2 月期间在葡萄牙的一家三级中心接受 AV 结消融的所有患者进行了详细的回顾性分析。
共有 123 名患者，平均年龄为 69±9 岁，52%为男性，接受了 AV 结消融。他们大多数在基线时患有心房颤动（65%）。在中位数为 8.5 年（四分位间距 3.8-11.8）的随访期间，患者的心衰（HF）功能分级得到改善（NYHA 分级 III-IV 级 46%对 13%，p=0.001），因 HF 住院（0.98±1.3 次对 0.28±0.8 次，p=0.001）和急诊科就诊（1.1±1 次对 0.17±0.7 次，p=0.0001）的次数减少。无器械相关并发症。尽管进行了永久性起搏器刺激，左心室射血分数也没有恶化（47±13%对 47%±12%，p=0.63）。有 28 名患者死亡（23%）。AV 结消融前因 HF 而就诊 ED 的次数是复合不良结局的独立预测因素（OR 1.8，95%CI 1.24-2.61，p=0.002）。
尽管需要起搏器依赖，但 AV 结消融在长期随访中仍具有临床获益。AV 结消融前因 HF 而就诊 ED 的次数是复合不良结局的独立预测因素。AV 结消融可能应更早地应用于室上性心律失常和 HF 的患者治疗中，特别是在不适合对特定心律失常进行选择性消融的情况下。
