Division of Cardiology, Department of Medicne, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Cardiology, Department of Medicne, Mount Sinai-Morningside Hospital, New York, New York, USA.
Pacing Clin Electrophysiol. 2022 Sep;45(9):1151-1159. doi: 10.1111/pace.14543. Epub 2022 Jun 10.
Data on long-term outcomes of catheter ablation (CA) for atrial fibrillation (AF) in outside of clinical trials settings are sparse.
We aimed to assess outcomes and readmissions at 1 year following admission for CA for AF.
Utilizing the Nationwide Readmissions Database (2016-2018), we identified patients with CA among all patients with a primary admission diagnosis of AF, and a control group by propensity score match adjusted for age, sex, comorbidities, CHA₂DS₂-VASc scores, and the hospital characteristics. The primary outcome was a composite of unplanned heart failure (HF), AF and stroke-related readmissions, and death at 1 year, and secondary outcomes were hospital outcomes and all-cause readmission rates.
The study cohort consisted of 29,771 patients undergoing CA and 63,988 controls. Patients undergoing CA were younger with lower CHA₂DS₂-VASc scores and less comorbidities. Over a follow-up of 170 ±1.1 days, the primary outcome occurred in 5.2% in CA group and 6.0% of controls (hazard ratio [HR] and 95% confidence interval [CI]: 0.86 [0.76-0.94], p = .002). CA affected AF and stroke related readmission, but showed no effect on HF and mortality outcome. Male sex (HR: 0.83 [0.74-0.94], p = .03), younger age (HR: 0.71 [0.61-0.83], p < .001], and lower CHA₂DS₂-VASc scores (HR: 0.68 [0.55-0.84], p < .001) were associated with lower risk of primary outcome with CA.
In this study, CA for AF was associated with significantly lower AF and stroke-related admissions, but not to HF or all-cause readmission. Better outcomes were seen among males, younger patients, and in patients with less comorbidities and low CHA₂DS₂-VASc scores.
在临床试验以外的环境中，关于导管消融（CA）治疗心房颤动（AF）的长期结果的数据很少。
我们旨在评估 CA 治疗 AF 患者入院后 1 年的结局和再入院情况。
利用全国再入院数据库（2016-2018 年），我们在所有因 AF 初次入院诊断的患者中识别出 CA 患者，并通过倾向评分匹配调整年龄、性别、合并症、CHA₂DS₂-VASc 评分和医院特征，为对照组匹配。主要结局是 1 年内无计划的心衰（HF）、AF 和中风相关的再入院和死亡的复合结局，次要结局是医院结局和全因再入院率。
研究队列包括 29771 例接受 CA 治疗的患者和 63988 例对照组。接受 CA 治疗的患者年龄较小，CHA₂DS₂-VASc 评分较低，合并症较少。在 170±1.1 天的随访中，CA 组的主要结局发生率为 5.2%，对照组为 6.0%（风险比 [HR]和 95%置信区间 [CI]：0.86 [0.76-0.94]，p=0.002）。CA 影响 AF 和中风相关的再入院，但对 HF 和死亡率没有影响。男性（HR：0.83 [0.74-0.94]，p=0.03）、年龄较小（HR：0.71 [0.61-0.83]，p<0.001）和较低的 CHA₂DS₂-VASc 评分（HR：0.68 [0.55-0.84]，p<0.001）与 CA 治疗后的主要结局风险降低相关。
在这项研究中，CA 治疗 AF 与 AF 和中风相关的再入院显著降低相关，但与 HF 或全因再入院无关。在男性、年龄较小的患者以及合并症较少和 CHA₂DS₂-VASc 评分较低的患者中，结局更好。
