Chang Ting-Yung, Chao Tze-Fan, Lin Chin-Yu, Lin Yenn-Jiang, Chang Shih-Lin, Lo Li-Wei, Hu Yu-Feng, Chung Fa-Po, Chen Shih-Ann
Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 Jan 1;86(1):11-18. doi: 10.1097/JCMA.0000000000000823. Epub 2022 Oct 13.
The recent Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial did not reveal any benefit of catheter ablation in patients with atrial fibrillation (AF), advanced heart failure (HF), and severely reduced left ventricular ejection fraction (LVEF). We hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in HF patients with AF and impaired left ventricular systolic function (LVEF <50%) as compared with only medical therapy.
We searched the literature for randomized clinical trials (RCTs) that compared RFCA to medical therapy in this population.
Compared with the medical therapy group, the RFCA group had significantly less all-cause mortality, HF hospitalization, and AF recurrence rates. The RFCA group had significantly higher peak oxygen consumption (VO 2max ), a better quality of life (Minnesota Living with Heart Failure Questionnaire score), and improved LVEF. However, RFCA for AF failed to reduce all-cause mortality in a specific meta-analysis of four RCTs that enrolled patients with LVEF ≤35%.
Compared with medical therapy, RFCA for AF in the setting of HF with impaired systolic function is associated with better clinical (HF hospitalization and all-cause mortality), structural (LVEF improvement), functional (VO 2max ), and quality of life outcomes. However, RFCA for AF failed to reduce all-cause mortality in RCTs that enrolled patients with LVEF ≤35% and thereby indicated the necessary stratification to identify patients who may benefit more from RFCA.
近期的心力衰竭合并房颤导管消融治疗试验未显示导管消融对房颤（AF）、晚期心力衰竭（HF）及左心室射血分数（LVEF）严重降低的患者有任何益处。我们假设，与单纯药物治疗相比，射频导管消融（RFCA）可改善合并房颤且左心室收缩功能受损（LVEF<50%）的HF患者的预后。
我们检索了比较该人群中RFCA与药物治疗的随机临床试验（RCT）的文献。
与药物治疗组相比，RFCA组的全因死亡率、HF住院率和房颤复发率显著更低。RFCA组的峰值耗氧量（VO₂max）显著更高，生活质量更好（明尼苏达心力衰竭生活问卷评分），LVEF有所改善。然而，在一项纳入LVEF≤35%患者的四项RCT的特定荟萃分析中，房颤的RFCA未能降低全因死亡率。
与药物治疗相比，收缩功能受损的HF合并房颤患者进行房颤的RFCA与更好的临床（HF住院率和全因死亡率）、结构（LVEF改善）、功能（VO₂max）和生活质量结局相关。然而，房颤的RFCA在纳入LVEF≤35%患者的RCT中未能降低全因死亡率，因此表明有必要进行分层以识别可能从RFCA中获益更多的患者。
