Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Europace. 2021 Aug 6;23(8):1252-1261. doi: 10.1093/europace/euaa420.
We aimed to examine the benefits of catheter ablation in patients with non-paroxysmal atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF.
From 1173 consecutive patients undergoing catheter ablation, 502 with non-paroxysmal AF were divided into three groups: no history of HF [plasma B-type natriuretic peptide (BNP) <100 pg/mL and no HF hospitalization; n = 125], HFpEF [left ventricular (LV) EF ≥50%; n = 293], and HF with midrange EF (HFmrEF) + HFrEF (LVEF <50%; n = 84) groups. The endpoints were AF recurrence at 1 year, changes in symptomatic and image-based functional status, and changes in BNP levels from baseline to 1 year. In the HFpEF group, AF recurred in 48 patients (16.4%) and 278 patients (94.8%) had sinus rhythm at 1 year; these values were comparable with those in the other groups. Significant improvement was observed in the left atrial diameter, LVEF, and New York Heart Association functional class in the HFpEF and HFmrEF + HFrEF groups. The BNP level significantly decreased irrespective of the index rate control status, and freedom from AF recurrence was an independent predictor of HF remission, defined as BNP <100 pg/mL at 1 year, in the HFpEF group.
Catheter ablation is highly feasible for restoring sinus rhythm in non-paroxysmal AF with coexisting HFpEF, thereby improving cardiac function and BNP levels. Catheter ablation for AF may be an optional management strategy.
本研究旨在比较导管消融术对非阵发性心房颤动（房颤）合并射血分数保留心衰（HFpEF）患者、合并射血分数降低心衰（HFrEF）患者和不合并心衰患者的疗效。
连续纳入 1173 例行导管消融术的患者，其中 502 例为非阵发性房颤患者，分为三组：无心衰史组（血浆 B 型利钠肽（BNP）<100pg/ml 且无心衰住院史；n=125）、HFpEF 组（左心室射血分数（LVEF）≥50%；n=293）和 HF 中间范围射血分数（HFmrEF）+HFrEF 组（LVEF<50%；n=84）。终点事件为 1 年时房颤复发、症状和基于影像学的功能状态变化以及 BNP 水平从基线至 1 年的变化。HFpEF 组中，48 例（16.4%）患者房颤复发，278 例（94.8%）患者在 1 年后恢复窦性心律，与其他两组相当。HFpEF 组和 HFmrEF+HFrEF 组的左心房直径、LVEF 和纽约心功能协会（NYHA）心功能分级均显著改善。不论是否指数心率控制良好，BNP 水平均显著降低，且 1 年后 BNP<100pg/ml 是 HFpEF 组 HF 缓解的独立预测因素。
导管消融术可有效恢复非阵发性房颤合并 HFpEF 患者的窦性心律，改善心功能和 BNP 水平。对于房颤患者，导管消融术可能是一种可选的治疗策略。
