意大利普利亚地区房颤消融患者的长期死亡率：一项回顾性、基于人群的流行病学研究。

Long-term mortality of patients ablated for atrial fibrillation: a retrospective, population-based epidemiological study in Apulia, Italy.

机构信息

Cardiology Department, Regional General Hospital 'F Miulli', Acquaviva delle Fonti, Italy

Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.

出版信息

BMJ Open. 2022 Apr 7;12(4):e058325. doi: 10.1136/bmjopen-2021-058325.

DOI:10.1136/bmjopen-2021-058325

PMID:35393325

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8991055/

Abstract

OBJECTIVES

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with substantial morbidity and mortality. Data on long-term risk and mortality after catheter ablation for AF are lacking. The aim of this study was to evaluate all-cause mortality and the long-term risk of death in patients who underwent catheter ablation for AF compared with the general population.

DESIGN

Retrospective, population-based epidemiological study.

SETTING

We analysed data from patients residing in Apulia region who underwent AF ablation between January 2009 and June 2019.

PARTICIPANTS

1260 patients (914 male, mean age 60±11 years).

OUTCOMES

Vital status and dates of death to 31 December 2019 were obtained by using regional Health Information System. The expected number of deaths was derived using mortality rates from the general regional population by considering age-specific and gender-specific death probability provided for each calendar year by the Italian National Institute of Statistics. Standardised mortality ratios (SMRs) were calculated by dividing the observed number of deaths among patients by the expected number of deaths estimated from the general population.

RESULTS

During follow-up (6449 person-years), 95 deaths were observed (1.47 deaths per 100 person-years). Although overall long-term mortality after AF ablation was not different to that of the general population (SMR 1.05 (95% CI 0.86 to 1.28; p=0.658)), the number of observed events was significantly increased in patients with heart failure (HF) at baseline or who developed HF during follow-up (SMR 2.40 (1.69 to 3.41; p<0.001) and 1.75 (1.17 to 2.64; p=0.007), respectively) and reduced in those without (SMR 0.63 (0.47 to 0.86; p=0.003)).

CONCLUSION

Long-term mortality of patients undergoing AF ablation is similar to that of the general population. Patients with HF had an increased risk while those without seem to have a better risk profile.

摘要

目的

心房颤动（AF）是最常见的持续性心律失常，与大量发病率和死亡率有关。关于 AF 导管消融后的长期风险和死亡率的数据尚缺乏。本研究的目的是评估与普通人群相比，接受 AF 导管消融治疗的患者的全因死亡率和长期死亡风险。

设计

回顾性、基于人群的流行病学研究。

地点

我们分析了 2009 年 1 月至 2019 年 6 月期间在普利亚大区接受 AF 消融治疗的患者的数据。

参与者

1260 名患者（914 名男性，平均年龄 60±11 岁）。

结局

通过使用区域卫生信息系统获取截至 2019 年 12 月 31 日的生存状态和死亡日期。预期死亡人数通过考虑特定年龄和性别特定死亡率，从普通地区人群的死亡率中得出，死亡率是意大利国家统计局每年为每个日历年提供的。标准化死亡率比（SMR）通过将患者中观察到的死亡人数除以从普通人群中估计的预期死亡人数来计算。

结果

在随访期间（6449 人年），观察到 95 例死亡（每 100 人年 1.47 例死亡）。尽管 AF 消融后总体长期死亡率与普通人群无差异（SMR 1.05（95%CI 0.86 至 1.28；p=0.658）），但基线有心衰（HF）或随访期间发生 HF 的患者的观察到的事件数量显著增加（SMR 分别为 2.40（1.69 至 3.41；p<0.001）和 1.75（1.17 至 2.64；p=0.007）），而无 HF 的患者则减少（SMR 0.63（0.47 至 0.86；p=0.003））。