Yazaki Kyoichiro, Ejima Koichiro, Kataoka Shohei, Higuchi Satoshi, Kanai Miwa, Yagishita Daigo, Shoda Morio, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan.
Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University Tokyo Japan.
Circ Rep. 2020 Nov 27;2(12):707-714. doi: 10.1253/circrep.CR-20-0111.
Atrial fibrillation (AF) ablation is associated with a good prognosis; nevertheless, the effect of post-procedural systolic function on a patient's prognosis remains uncertain. Of 1,077 consecutive patients undergoing AF ablation, the prognosis of 150 patients with abnormal left ventricular ejection fraction (LVEF; <50%) was evaluated. Patients were categorized as having reduced LVEF (rEF; LVEF <40%), mid-range ejection fraction (mrEF; 40%≤LVEF<50%), or preserved LVEF (pEF; LVEF ≥50%). Post-procedural LVEF, evaluated 3 months after the procedure, was post-rEF in 28 patients (19%), post-mrEF in 49 (33%), and post-pEF in 73 (49%). During the median follow-up of 31 months, the cumulative ratios of the composite outcome (heart failure hospitalization or death) in the post-rEF, post-mrEF, and post-pEF groups were 18%, 5%, and 2%, respectively, at 1 year and 50%, 13%, and 4%, respectively, at 3 years (P<0.0001). The post-rEF group had a 4.5- to 5.0-fold higher risk of the outcome compared with the post-pEF group, whereas the post-mrEF group showed no risk after adjusting for confounders, including age ≥65 years, preprocedural LVEF category, and recurrence of atrial tachyarrhythmia. Patients with post-mrEF had a comparable prognosis to those with post-pEF over a relatively long follow-up, whereas those with post-rEF had the poorest outcome of the 3 groups, regardless of preprocedural LVEF status.
心房颤动（AF）消融术具有良好的预后；然而，术后收缩功能对患者预后的影响仍不确定。在1077例连续接受AF消融术的患者中，对150例左心室射血分数（LVEF；<50%）异常的患者的预后进行了评估。患者被分为左心室射血分数降低（rEF；LVEF<40%）、射血分数中等范围（mrEF；40%≤LVEF<50%）或左心室射血分数保留（pEF；LVEF≥50%）。术后3个月评估的术后LVEF情况为：28例（19%）为rEF，49例（33%）为mrEF，73例（49%）为pEF。在31个月的中位随访期内，rEF组、mrEF组和pEF组复合结局（心力衰竭住院或死亡）的累积发生率在1年时分别为18%、5%和2%，在3年时分别为50%、13%和4%（P<0.0001）。与pEF组相比，rEF组出现该结局的风险高4.5至5.0倍，而在对包括年龄≥65岁、术前LVEF类别和房性快速性心律失常复发等混杂因素进行校正后，mrEF组未显示出风险。在相对较长的随访期内，mrEF组患者的预后与pEF组患者相当，而rEF组患者是三组中预后最差的，无论术前LVEF状态如何。
