Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Center for Clinical and Translational Research of Kyushu University Hospital, Fukuoka, Japan.
JACC Clin Electrophysiol. 2023 Sep;9(9):1948-1959. doi: 10.1016/j.jacep.2023.05.038. Epub 2023 Jul 19.
Advances in catheter ablation (CA) for atrial fibrillation (AF) have improved the prognosis of patients with heart failure (HF) and AF. However, its optimal timing remains to be fully elucidated.
The aim of this study was to investigate the prognostic impact of early CA in patients with HF and AF hospitalized for worsening HF.
From JROADHF (Japanese Registry of Acute Decompensated Heart Failure) (n = 13,238), patients with HF and AF who underwent CA within 90 days after admission for HF (early CA; n = 103) and those who did not (control; n = 2,683) were identified. Mortality was compared between these groups in the crude cohort, as well as in the propensity-matched cohort (n = 83 in each group).
In the crude cohort, all-cause mortality was significantly lower in the early CA group than in the control group (log-rank P < 0.001; HR: 0.38; 95% CI: 0.24-0.60). In the matched cohort, all-cause mortality was likewise significantly lower in the early CA group (log-rank P = 0.014; HR: 0.47; 95% CI: 0.25-0.88). Cardiovascular death and HF mortality were significantly lower in both cohorts (crude: Gray' test: P < 0.001 and P = 0.005; subdistribution HR: 0.28 [95% CI: 0.13-0.63] and HR: 0.31 [95% CI: 0.13-0.75]; matched: Gray's test: P = 0.006 and P = 0.017; subdistribution HR: 0.24 [95% CI: 0.08-0.70] and HR: 0.28 [95% CI: 0.09-0.84], respectively).
In a nationwide representative real-world cohort, CA for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death in patients with HF and AF.
心房颤动（AF）的导管消融术（CA）的进步改善了心力衰竭（HF）和 AF 患者的预后。然而，其最佳时机仍有待充分阐明。
本研究旨在探讨 HF 恶化住院患者早期 CA 对 HF 合并 AF 患者的预后影响。
从 JROADHF（日本急性失代偿性心力衰竭登记研究）（n=13238）中，确定了在 HF 入院后 90 天内接受 CA（早期 CA；n=103）和未接受 CA（对照组；n=2683）的 HF 合并 AF 患者。在未校正队列以及倾向匹配队列（每组 83 例）中比较两组间的死亡率。
在未校正队列中，早期 CA 组的全因死亡率明显低于对照组（log-rank P<0.001；HR：0.38；95%CI：0.24-0.60）。在匹配队列中，早期 CA 组的全因死亡率也明显较低（log-rank P=0.014；HR：0.47；95%CI：0.25-0.88）。两个队列的心血管死亡和 HF 死亡率均显著降低（未校正：Gray 检验：P<0.001 和 P=0.005；亚分布 HR：0.28 [95%CI：0.13-0.63] 和 HR：0.31 [95%CI：0.13-0.75]；匹配：Gray 检验：P=0.006 和 P=0.017；亚分布 HR：0.24 [95%CI：0.08-0.70] 和 HR：0.28 [95%CI：0.09-0.84]）。
在全国代表性的真实世界队列中，HF 入院后 90 天内进行 AF 的 CA 与 HF 合并 AF 患者的长期预后改善相关，包括心血管和 HF 死亡。
