射血分数保留的心力衰竭患者行导管消融治疗心房颤动的长期事件。
Long-term events following catheter-ablation for atrial fibrillation in heart failure with preserved ejection fraction.
机构信息
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Department of Cardiology, Ube-Kohsan Central Hospital, Ube, Japan.
出版信息
ESC Heart Fail. 2022 Oct;9(5):3505-3518. doi: 10.1002/ehf2.14079. Epub 2022 Jul 27.
AIMS
Data regarding prognostic events following catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) are scarce. We conducted this study to compare the incidence of major adverse clinical events (MACE) following CA for AF between patients with HFpEF and those with systolic heart failure (HF).
METHODS AND RESULTS
This single-centre observational study included 142 patients with HF who underwent CA for AF (median follow-up: 4.0 [2.6, 6.3] years). The patients were grouped based on the presence of HFpEF (n = 84) and systolic HF (left ventricular ejection fraction <50%, n = 58). We compared the cumulative incidence and incidence rate of MACE, comprising all-cause death, unplanned cardiovascular hospitalization (CVH), and HF hospitalization (HFH) between both groups and the number of HFH before and after CA in each group. Multivariate analysis was performed to identify the predictors of MACE in patients with HFpEF. The incidence of MACE was comparable between the groups (following the first procedure: HFpEF: 23%, 4.7/100 person-years, vs. systolic HF: 28%, 6.6/100 person-years, P = 0.18; last procedure: 20%, 4.8/100 person-years, vs. 24%, 6.9/100 person-years, P = 0.21). Although the incidence of HFH was lower in patients with HFpEF than in those with systolic HF (first procedure: 14%, 2.9/100 person-years, vs. 24%, 5.7/100 person-years, P = 0.07; last procedure: 11%, 2.5/100 person-years, vs. 24%, 6.9/100 person-years, P = 0.01), the incidence of CVH was higher (first procedure: 8%, 1.7/100 person-years, vs. 5%, 1.2/100 person-years, P = 0.74; last procedure: 6%, 1.4/100 person-years, vs. 2%, 0.5/100 person-years, P = 0.4). The number of HFH significantly decreased in both groups after CA (HFpEF: 1 hospitalization [the first and third quartiles: 0, 1] in pre-CA, vs. 0 hospitalizations [0, 0] in post-CA, P < 0.0001; systolic HF: 1 hospitalization [0, 1], vs. 0 hospitalizations [0, 0], P < 0.005). The proportion of HFH among total clinical events was significantly smaller in patients with HFpEF than in those with systolic HF (following the first procedure: 56% vs. 88%, P < 0.005; last procedure: 52% vs. 92%, P < 0.005).
CONCLUSIONS
CA for AF could be beneficial for patients with HFpEF, similar to those with systolic HF. However, clinical events other than HFH should be considered cautiously in such patients.
目的
心力衰竭伴射血分数保留（HFpEF）患者行导管消融（CA）治疗心房颤动（AF）后预后事件的数据较为匮乏。本研究旨在比较 HFpEF 与收缩性心力衰竭（HF）患者行 CA 治疗 AF 后主要不良临床事件（MACE）的发生率。
方法和结果
本单中心观察性研究纳入了 142 例因 AF 而行 CA 治疗的 HF 患者（中位随访时间：4.0[2.6，6.3]年）。根据 HFpEF （n=84）和收缩性 HF（左心室射血分数＜50%，n=58）的存在情况对患者进行分组。我们比较了两组间的 MACE（包括全因死亡、非计划心血管住院[CVH]和 HF 住院[HFH]）的累积发生率和发生率，以及每组 CA 前后的 HFH 数量。采用多变量分析确定 HFpEF 患者 MACE 的预测因素。两组间 MACE 的发生率无差异（首次治疗：HFpEF：23%，4.7/100 人年，与收缩性 HF：28%，6.6/100 人年，P=0.18；末次治疗：20%，4.8/100 人年，与收缩性 HF：24%，6.9/100 人年，P=0.21）。虽然 HFpEF 患者的 HFH 发生率低于收缩性 HF 患者（首次治疗：14%，2.9/100 人年，与收缩性 HF：24%，5.7/100 人年，P=0.07；末次治疗：11%，2.5/100 人年，与收缩性 HF：24%，6.9/100 人年，P=0.01），但 CVH 的发生率更高（首次治疗：8%，1.7/100 人年，与收缩性 HF：5%，1.2/100 人年，P=0.74；末次治疗：6%，1.4/100 人年，与收缩性 HF：2%，0.5/100 人年，P=0.4）。两组患者 CA 后 HFH 的数量均显著减少（HFpEF：CA 前为 1 次住院[第 1 和第 3 四分位数：0，1]，CA 后为 0 次住院[0，0]，P＜0.0001；收缩性 HF：CA 前为 1 次住院[0，1]，CA 后为 0 次住院[0，0]，P＜0.005）。HFpEF 患者的 HFH 占总临床事件的比例明显低于收缩性 HF 患者（首次治疗：56%，与 88%，P＜0.005；末次治疗：52%，与 92%，P＜0.005）。
结论
CA 治疗 AF 对 HFpEF 患者可能有益，与收缩性 HF 患者相似。然而，对于此类患者，应谨慎考虑除 HFH 以外的临床事件。
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