与药物治疗相比，接受导管消融术的心房颤动和心力衰竭患者生存率提高：一项随机对照试验的系统评价和荟萃分析。
Improved survival in patients with atrial fibrillation and heart failure undergoing catheter ablation compared to medical treatment: A systematic review and meta-analysis of randomized controlled trials.
作者信息
Romero Jorge, Gabr Mohamed, Alviz Isabella, Briceno David, Diaz Juan Carlos, Rodriguez Daniel, Patel Kavisha, Polanco Dalvert, Trivedi Chintan, Mohanty Sanghamitra, Della Rocca Domenico, Lakkireddy Dhanunjaya, Natale Andrea, Di Biase Luigi
机构信息
Department of Medicine, Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA.
St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas, USA.
出版信息
J Cardiovasc Electrophysiol. 2022 Nov;33(11):2356-2366. doi: 10.1111/jce.15622. Epub 2022 Aug 10.
INTRODUCTION
Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy.
METHODS AND RESULTS
A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% confidence interval [CI] 0.51-0.83, p = .0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of all-atrial arrhythmia recurrence were significantly lower in the CA group (39.9% vs. 69.6%, RR: 0.55, 95% CI: 0.40-0.76, p = .0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ± 7.6%) as compared to conventional treatment (+3.3 ± 8%) (mean difference 6.2, 95% CI: 3.6-8.8, p < .00001).
CONCLUSION
CA for AF in patients with HF decreases all-cause mortality, improves all-atrial arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Nonetheless, the benefit of CA in patients with severely reduced ejection fraction and New York Heart Association class IV HF has not been clearly elucidated.
引言
越来越多的证据表明，与药物治疗相比，心力衰竭（HF）合并心房颤动（AF）患者接受导管消融（CA）可改善预后。我们试图研究与药物治疗相比，CA对AF合并HF患者预后的益处。
方法与结果
对PubMed、Embase和Cochrane临床试验中心注册库进行系统综述，以评估CA对AF合并HF患者益处的临床研究。主要终点是全因死亡率。次要终点包括房性心律失常复发和左心室射血分数（LVEF）改善情况。纳入8项随机对照试验，共2121例患者（平均年龄：65±5岁；72%为男性）。平均随访时间为32.9±14.5个月。接受CA治疗的患者全因死亡率显著低于药物治疗组（8.8%对13.5%，RR 0.65，95%置信区间[CI] 0.51-0.83，p = .0005）。CA治疗使全因死亡率相对风险降低35%，绝对风险降低4.7%。CA组所有房性心律失常复发率显著更低（39.9%对69.6%，RR：0.55，95% CI：0.40-0.76，p = .0003）。与传统治疗组（+3.3±8%）相比，接受CA治疗的患者LVEF改善显著更高（+9.4±7.6%）（平均差值6.2，95% CI：3.6-8.8，p < .00001）。
结论
与药物治疗相比，HF合并AF患者接受CA可降低全因死亡率，改善所有房性心律失常复发率和LVEF。对于这部分特定患者群体，应考虑将CA作为改善生存的首选治疗方法。尽管如此，CA在射血分数严重降低和纽约心脏协会IV级HF患者中的益处尚未明确阐明。
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