Su Xin, DU Xin, Lu Shang-Xin, Jiang Chao, DU Jing, Xia Shi-Jun, Dong Zhao-Jie, Jia Zhao-Xu, Long De-Yong, Sang Cai-Hua, Tang Ri-Bo, Liu Nian, Li Song-Nan, Bai Rong, Dong Jian-Zeng, Ma Chang-Sheng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China.
Heart Health Research Center, Beijing, China.
J Geriatr Cardiol. 2020 Dec 28;17(12):740-749. doi: 10.11909/j.issn.1671-5411.2020.12.008.
It is unclear whether catheter ablation (CA) for atrial fibrillation (AF) affects the long-term prognosis in the elderly. This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.
Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study. Participants who underwent CA at baseline were propensity score matched (1:1) with those who did not receive CA. The outcome events included all-cause mortality, cardiovascular mortality, stroke/transient ischemic attack (TIA), and cardiovascular hospitalization.
Overall, this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions. During a mean follow-up of 39.75 ± 19.98 months (minimum six months), 24 patients died in the ablation group, compared with 60 deaths in the non-ablation group [hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.30-0.79, = 0.0024]. Besides, 6 ablated and 29 non-ablated subjects died of cardiovascular disease (HR = 0.25, 95% CI: 0.11-0.61, = 0.0022). A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA (HR = 0.79, 95% CI: 0.48-1.28, = 0.3431). In addition, 140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization (HR = 0.84, 95% CI: 0.67-1.04, = 0.1084). Subgroup analyses according to gender, type of AF, time since onset of AF, and anticoagulants exposure in initiation did not show significant heterogeneity.
In elderly patients with AF, CA may be associated with a lower incidence of all-cause and cardiovascular mortality.
心房颤动（AF）导管消融（CA）是否影响老年人的长期预后尚不清楚。本研究旨在评估CA与老年AF患者长期预后之间的关系。
2011年8月至2017年12月期间，前瞻性纳入中国心房颤动注册研究中75岁以上的非瓣膜性AF患者。基线时接受CA的参与者与未接受CA的参与者进行倾向评分匹配（1:1）。结局事件包括全因死亡、心血管死亡、中风/短暂性脑缺血发作（TIA）和心血管住院。
总体而言，该队列包括571例接受消融的患者和571例未接受消融的患者，在18个维度上具有相似特征。在平均随访39.75±19.98个月（最短6个月）期间，消融组有24例患者死亡，非消融组有60例死亡[风险比（HR）=0.49，95%置信区间（CI）：0.30-0.79，P=0.0024]。此外，6例接受消融和29例未接受消融的受试者死于心血管疾病（HR=0.25，95%CI：0.11-0.61，P=0.0022）。共有27例接受消融和40例未接受消融的患者发生中风/TIA（HR=0.79，95%CI：0.48-1.28，P=0.3431）。此外，140例接受消融和194例未接受消融的参与者发生心血管住院（HR=0.84，95%CI：0.67-1.04，P=0.1084）。根据性别、AF类型、AF发作时间和起始抗凝药物暴露进行的亚组分析未显示出显著异质性。
在老年AF患者中，CA可能与全因和心血管死亡率较低有关。
