Usuda Keisuke, Kato Takeshi, Tsuda Toyonobu, Tada Hayato, Niwa Satoru, Usui Soichiro, Sakata Kenji, Hayashi Kenshi, Furusho Hiroshi, Kawashiri Masaaki, Takamura Masayuki, Otsuka Takayuki, Suzuki Shinya, Hirata Akio, Murakami Masato, Takami Mitsuru, Kimura Masaomi, Fukaya Hidehira, Nakahara Shiro, Shimizu Wataru, Iwasaki Yu-Ki, Hayashi Hiroshi, Harada Tomoo, Nakajima Ikutaro, Okumura Ken, Koyama Junjiroh, Tokuda Michifumi, Yamane Teiichi, Momiyama Yukihiko, Tanimoto Kojiro, Soejima Kyoko, Nonoguchi Noriko, Ejima Koichiro, Hagiwara Nobuhisa, Harada Masahide, Sonoda Kazumasa, Inoue Masaru, Kumagai Koji, Hayashi Hidemori, Satomi Kazuhiro, Yazaki Yoshinao, Watari Yuji, Arai Masaru, Watanabe Ryuta, Yokoyama Katsuaki, Matsumoto Naoya, Nagashima Koichi, Okumura Yasuo
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan.
Heart Vessels. 2022 Feb;37(2):327-336. doi: 10.1007/s00380-021-01929-5. Epub 2021 Sep 15.
The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. We investigated 3326 consecutive patients (25.8% female, mean age 63.3 ± 10.3 years) who underwent catheter ablation for AF from the atrial fibrillation registry to follow the long-term outcomes and use of anti coagulants after ablation (AF frontier ablation registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 24.0 months, 2339 (70.3%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 144 (4.3%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.8 per 100 person-years) compared with the AF recurrence group (3.0 per 100 person-years, p = 0.003). The multivariate analysis revealed that freedom from AF (hazard ratio 0.61, 95% confidence interval 0.44-0.86, p = 0.005) was independently associated with the incidence of the composite event. In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.
导管消融治疗心房颤动（AF）对心血管事件和死亡率的影响存在争议。我们从一个日本多中心房颤消融队列研究了窦性心律维持对房颤消融后主要不良心脑血管事件的影响。我们从房颤登记处调查了3326例连续接受导管消融治疗房颤的患者（女性占25.8%，平均年龄63.3±10.3岁），以追踪长期预后及消融后抗凝药物的使用情况（房颤前沿消融登记处）。主要终点是卒中、短暂性脑缺血发作、心血管事件和全因死亡的复合终点。在平均24.0个月的随访期间，2339例（70.3%）患者导管消融后无房颤，144例（4.3%）患者发生主要复合终点事件。房颤未复发组主要终点事件的发生率（每100人年1.8例）显著低于房颤复发组（每100人年3.0例，p=0.003）。多变量分析显示，无房颤（风险比0.61，95%置信区间0.44-0.86，p=0.005）与复合事件的发生率独立相关。在多中心房颤消融队列中，导管消融后窦性心律维持与较低的主要不良心脑血管事件发生率独立相关。
