Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA USA.
Department of Medicine University of Pittsburgh Medical Center McKeesport PA USA.
J Am Heart Assoc. 2023 Jul 18;12(14):e029339. doi: 10.1161/JAHA.122.029339. Epub 2023 Jul 14.
Background Despite the high burden of atrial fibrillation in cardiac amyloidosis (CA), the safety of catheter ablation therapy in CA is not well established. We sought to examine short-term safety outcomes following atrial fibrillation ablation in patients with CA compared with matched patients with dilated cardiomyopathy (DCM). Methods and Results Using data from the National Inpatient Sample, we identified all hospitalizations for atrial fibrillation ablation from the fourth quarter of 2015 through 2019. Admissions for CA and DCM were matched in a 1:5 ratio using propensity scores based on the following sociodemographics: age, sex, race or ethnicity, payor, median income, comorbidities, and hospital characteristics. We compared in-hospital outcomes between both cardiomyopathies. We identified 1395 unweighted hospitalizations (representing 6750 national hospitalizations) for atrial fibrillation ablation, out of which 45 (3.2%) were admissions for CA. Compared with DCM, patients with CA were older (72.9 versus 65.1 years), had a higher burden of prior stroke (20.0% versus 8.6%) and chronic kidney disease (53.3% versus 33.6%), and were less likely to have a prior implantable cardioverter-defibrillator (4.4% versus 23.0%). We successfully matched 42 CAs to 210 DCM hospitalizations. After matching, there was no difference in total complications (14.3% versus 10.5%, =0.60), length-of-stay (3.1 versus 2.1 days, =0.23), home disposition (97.6% versus 96.2%, =0.65), and total charges ($137 250 versus $133 910, =0.24). Conclusions In this nationally representative study of atrial fibrillation catheter ablation in CA, short-term safety outcomes and complication rates were similar to a propensity score-matched cohort of DCM. Further studies exploring long-term safety outcomes are needed.
尽管心房颤动在心脏淀粉样变（CA）中负担很高，但 CA 患者导管消融治疗的安全性尚未得到充分证实。我们试图研究与匹配的扩张型心肌病（DCM）患者相比，CA 患者行心房颤动消融后的短期安全性结局。
利用国家住院患者样本中的数据，我们从 2015 年第四季度到 2019 年确定了所有因心房颤动消融而住院的患者。使用基于以下社会人口统计学因素的倾向评分，以 1:5 的比例匹配 CA 和 DCM 的住院患者：年龄、性别、种族或民族、支付人、中位数收入、合并症和医院特征。我们比较了两种心肌病的住院结局。我们发现 1395 例未加权的因心房颤动消融而住院的患者（代表全国 6750 例住院患者），其中 45 例（3.2%）为 CA 入院。与 DCM 相比，CA 患者年龄更大（72.9 岁 vs. 65.1 岁），既往卒中（20.0% vs. 8.6%）和慢性肾脏病（53.3% vs. 33.6%）负担更重，且不太可能有植入式心脏复律除颤器（4.4% vs. 23.0%）。我们成功匹配了 42 例 CA 与 210 例 DCM 住院患者。匹配后，总并发症（14.3% vs. 10.5%，=0.60）、住院时间（3.1 天 vs. 2.1 天，=0.23）、出院方式（97.6% vs. 96.2%，=0.65）和总费用（$137250 美元 vs. $133910 美元，=0.24）均无差异。
在这项针对 CA 患者心房颤动导管消融的全国代表性研究中，短期安全性结局和并发症发生率与 DCM 患者的倾向评分匹配队列相似。需要进一步研究来探索长期安全性结局。
