Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Centre, Nara 636-0802, Japan.
Internal Medicine, Naito Hospital, Osaka 537-0002, Japan.
Europace. 2022 Apr 5;24(4):576-586. doi: 10.1093/europace/euab201.
Heart failure (HF) prognosis has been reported similar in patients with preserved vs. reduced left ventricular ejection fraction (LVEF). This study compared the long-term prognosis of HF patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF).
Among 5010 patients undergoing RFCA in Kansai Plus AF registry, 656 patients (13.1%) with a documented history of HF were enrolled in the study before RFCA. The primary endpoint was a composite of all-cause death, HF hospitalization, and stroke or systemic embolism. Patients with reduced (<40%), mid-range (40-49%), and preserved (≥50%) LVEF were 98 (14.9%), 107 (16.3%), and 451 (68.8%) patients, respectively. The prevalence of ischaemic heart disease and cardiomyopathies was higher among patients with reduced as compared with preserved LVEF (27.6% vs. 10.0%, P < 0.05 and 36.7% vs. 15.3%, P < 0.05, respectively). The median follow-up period was 2.9 years. The 3-year cumulative risk for the primary endpoint was higher in patients with reduced LVEF (32.7%) compared to those with mid-range (11.7%) or preserved (11.6%) LVEF (P < 0.001). Reduced LVEF was the most significant independent risk factor for primary endpoint (hazard ratio, 2.83; 95% confidence interval 1.74-4.61, P < 0.001). The 3-year arrhythmia recurrence rate was similar among the groups (48.2%, 42.8%, and 47.3%, respectively, P = 0.75).
This study raises hypothesis that patients with HFrEF and AF had approximately three times higher risk for a composite of all-cause death, HF hospitalization, and stroke or systemic embolism after AF ablation compared with patients with HFmrEF or HFpEF.
心力衰竭（HF）的预后在左心室射血分数（LVEF）保留与降低的患者中已有报道类似。本研究比较了接受射频导管消融（RFCA）治疗心房颤动（AF）的 HF 患者的长期预后。
在 Kansai Plus AF 注册研究中，5010 例行 RFCA 的患者中，有 656 例（13.1%）在 RFCA 前有 HF 病史记录，纳入本研究。主要终点是全因死亡、HF 住院和卒中和全身性栓塞的复合终点。LVEF 降低（<40%）、中值范围（40-49%）和保留（≥50%）的患者分别为 98（14.9%）、107（16.3%）和 451（68.8%）例。与保留 LVEF 的患者相比，LVEF 降低的患者中缺血性心脏病和心肌病的患病率更高（27.6%比 10.0%，P<0.05 和 36.7%比 15.3%，P<0.05）。中位随访时间为 2.9 年。LVEF 降低的患者（32.7%）主要终点的 3 年累积风险高于中值范围（11.7%）或保留（11.6%）的患者（P<0.001）。LVEF 降低是主要终点的最显著独立危险因素（风险比，2.83；95%置信区间 1.74-4.61，P<0.001）。各组间的 3 年心律失常复发率相似（分别为 48.2%、42.8%和 47.3%，P=0.75）。
本研究提出假设，与 HFmrEF 或 HFpEF 患者相比，HF 合并左心室射血分数降低的 AF 患者接受 AF 消融后全因死亡、HF 住院和卒中和全身性栓塞的复合终点风险增加约 3 倍。
