导管消融治疗伴有明显功能性二尖瓣反流的心房颤动的疗效。

Efficacy of catheter ablation for atrial fibrillation in patients with significant functional mitral regurgitation.

机构信息

Department of Cardiology, Anyang People's Hospital, Anyang, China.

Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.

出版信息

Medicine (Baltimore). 2023 Mar 10;102(10):e33231. doi: 10.1097/MD.0000000000033231.

DOI:10.1097/MD.0000000000033231

PMID:36897680

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9997827/

Abstract

BACKGROUND

Catheter ablation has been established to be an effective therapy for paroxysmal atrial fibrillation (AF) and is recommended as the treatment of choice for many patients, including those with clinically significant functional mitral regurgitation (MR). However, there is little information available about the clinical efficacy of catheter ablation for paroxysmal AF in patients with significant functional MR.

METHODS

We performed a retrospective study of 247 patients with paroxysmal AF who underwent AF ablation. The study included 28 (11.3%) patients with significant functional MR and 219 (88.7%) without significant functional MR. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting >30 seconds beyond 3 months after catheter ablation.

RESULTS

During a mean follow-up of 20.1 ± 7.4 months (range, 3-36 months), 45 (18.2%) patients developed recurrence of AF. The recurrence rate of AF was higher in patients with significant functional MR than in those without significant functional MR (42.9% vs 15.1%; P < .001). Univariable Cox proportional hazards regression analysis showed that significant functional MR (hazard ratio [HR], 3.46; 95% confidence interval [CI], 1.78-6.72; P < .001), age (HR, 1.04; 95% CI, 1.01-1.08; P = .009), the CHA2DS2-VASc score (HR, 1.28; 95% CI, 1.05-1.56; P = .017), and heart failure (HR, 4.71; 95% CI, 1.85-11.96; P = .001) were associated with the risk of recurrence. Multivariable analysis showed that significant functional MR (HR, 2.48; 95% CI, 1.21-5.05; P = .013), age (HR, 1.04; 95% CI, 1.00-1.07; P = .031), and heart failure (HR, 3.39; 95% CI, 1.27-9.03; P = .015) were independent predictors of AF recurrence.

CONCLUSION

Patients with significant functional MR have an increased risk of AF recurrence after catheter ablation.

摘要

背景

导管消融术已被确立为阵发性心房颤动（房颤）的有效治疗方法，被推荐作为许多患者的首选治疗方法，包括那些有临床显著功能性二尖瓣反流（MR）的患者。然而，关于导管消融术治疗有显著功能性 MR 的阵发性房颤患者的临床疗效的信息很少。

方法

我们对 247 例接受房颤消融术的阵发性房颤患者进行了回顾性研究。该研究包括 28 例（11.3%）有显著功能性 MR 的患者和 219 例（88.7%）无显著功能性 MR 的患者。房颤复发定义为导管消融后 3 个月以上出现持续 >30 秒的证实性房性心动过速/心房扑动。

结果

在平均 20.1±7.4 个月（范围 3-36 个月）的随访中，45 例（18.2%）患者发生房颤复发。有显著功能性 MR 的患者房颤复发率高于无显著功能性 MR 的患者（42.9% vs 15.1%；P<.001）。单变量 Cox 比例风险回归分析显示，显著功能性 MR（风险比[HR]，3.46；95%置信区间[CI]，1.78-6.72；P<.001）、年龄（HR，1.04；95% CI，1.01-1.08；P=.009）、CHA2DS2-VASc 评分（HR，1.28；95% CI，1.05-1.56；P=.017）和心力衰竭（HR，4.71；95% CI，1.85-11.96；P=.001）与复发风险相关。多变量分析显示，显著功能性 MR（HR，2.48；95% CI，1.21-5.05；P=.013）、年龄（HR，1.04；95% CI，1.00-1.07；P=.031）和心力衰竭（HR，3.39；95% CI，1.27-9.03；P=.015）是房颤复发的独立预测因素。