Qiao Yu, Zhao Zhen, Cai Xiang, Guo Yulong, Fu Mingpeng, Liu Ke, Guo Jinrui, Guo Tao, Niu Guodong
Department of Cardiac Arrhythmia, Fuwai Yunnan Cardiovascular Hospital, Kunming Medical University, Kunming, China.
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Sep 20;9:922910. doi: 10.3389/fcvm.2022.922910. eCollection 2022.
The long-term outcomes of ablation index (AI)-guided radiofrequency catheter ablation (RFCA) on atrial fibrillation (AF) and different subtypes of heart failure (HF) remain unknown. The aim of the study was to evaluate the long-term prognosis of AI-guided RFCA procedures in patients with AF and concomitant HF.
We retrospectively included consecutive patients with AF and HF who underwent the initial RFCA procedure with AI guidance from March 2018 to June 2021 in our institution. The patients were categorized into two groups: HF with preserved ejection fraction (HFpEF) group and HF with mid-range ejection fraction (HFmrEF) +HF with reduced ejection fraction (HFrEF) group.
A total of 101 patients were included. HFpEF and HFmrEF + HFrEF groups consisted of 71 (70.3%) and 30 patients (29.7%), respectively. During a median follow-up of 32.0 (18.2, 37.6) months, no significant difference was detected in AF recurrence between groups (21.1 . 33.3%) after multiple procedures, whereas the incidence of the composite endpoint of all-cause death, thromboembolic events, and HF hospitalization was significantly lower in HFpEF group (9.9 . 25.0%, Log-rank = 0.018). In multivariable analysis, a history of hypertension [hazard ratio () 4.667, 95% confidence interval () 1.433-15.203, = 0.011], left ventricular ejection fraction (LVEF) < 50% ( 5.390, 95% 1.911-15.203, = 0.001) and recurrent AF after multiple procedures ( 7.542, 95% 2.355-24.148, = 0.001) were independently associated with the incidence of the composite endpoint.
Long-term success could be achieved in 75% of patients with AF and concomitant HF after AI-guided RFCA procedures, irrespective of different HF subtypes. Preserved LVEF was associated with a reduction in the composite endpoint compared with impaired LVEF. Patients with recurrent AF tend to have a poorer prognosis.
消融指数（AI）引导下的射频导管消融术（RFCA）治疗心房颤动（AF）及不同亚型心力衰竭（HF）的长期疗效尚不清楚。本研究旨在评估AI引导下RFCA治疗AF合并HF患者的长期预后。
我们回顾性纳入了2018年3月至2021年6月在我院接受首次AI引导下RFCA手术的连续性AF合并HF患者。患者分为两组：射血分数保留的HF（HFpEF）组和射血分数中等范围的HF（HFmrEF）+射血分数降低的HF（HFrEF）组。
共纳入101例患者。HFpEF组和HFmrEF + HFrEF组分别有71例（70.3%）和30例（29.7%）。在中位随访32.0（18.2，37.6）个月期间，多次手术后两组间AF复发无显著差异（21.1. 33.3%）；而HFpEF组全因死亡、血栓栓塞事件和HF住院的复合终点发生率显著较低（9.9. 25.0%，对数秩检验 = 0.018）。多变量分析中，高血压病史[风险比（HR）4.667，95%置信区间（CI）1.433 - 15.203，P = 0.011]、左心室射血分数（LVEF）<50%（5.390，95% CI 1.911 - 15.203，P = 0.001）和多次手术后AF复发（7.542，95% CI 2.355 - 24.148，P = 0.001）与复合终点发生率独立相关。
AI引导下RFCA术后，75%的AF合并HF患者可获得长期成功，无论HF亚型如何。与LVEF受损相比，LVEF保留与复合终点降低相关。AF复发患者预后往往较差。
