Department of Cardiovascular Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan.
Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan.
Aging (Albany NY). 2023 Aug 14;15(15):7343-7361. doi: 10.18632/aging.204952.
Catheter ablation of atrial fibrillation (AF) is recommended for selected older patients. However, the preventive effects of AF ablation on cardiovascular events and death remain unclear, especially in older patients. This study aimed to investigate the impact of AF ablation on the incidence of cardiovascular events and death in very old nonvalvular AF (NVAF) patients.
We conducted a prospective cohort study of consecutive patients with NVAF aged ≥80 years and using direct oral anticoagulants (DOACs). We defined cardiovascular events as acute heart failure (AHF), strokes and systemic embolisms (SSEs), acute coronary syndrome (ACS), and sudden cardiac death (SCD) and cardiovascular death as AHF/SSE/ACS-related death and SCD. We compared the 3-year incidence of cardiovascular events and death between the patients who underwent AF ablation (Ablation group) and those who received medical therapy only (Medication group).
Among the 782 NVAF patients using DOACs, propensity score matching provided 208 patients in each group. The Ablation group had a significantly lower 3-year incidence of cardiovascular events and death than the Medication group: cardiovascular events, 24 (13.2%) vs. 43 (23.3%), log-rank = 0.009 and hazard ratio (HR) 0.52 (95% confidence interval (CI) 0.32-0.86) and cardiovascular deaths, 5 (3.0%) vs. 15 (7.8%), log-rank = 0.019 and HR 0.32 (95% CI 0.16-0.88).
In very old NVAF patients using DOACs, those who underwent AF ablation had a lower incidence of both cardiovascular events and death than those who received medical therapy only.
对于某些特定的老年患者，推荐使用导管消融术治疗心房颤动（房颤）。然而，房颤消融术对心血管事件和死亡的预防效果仍不明确，特别是在老年患者中。本研究旨在探讨房颤消融术对使用直接口服抗凝药物（DOACs）的高龄（≥80 岁）非瓣膜性房颤（NVAF）患者发生心血管事件和死亡的影响。
我们对连续使用 DOACs 的高龄（≥80 岁）NVAF 患者进行了前瞻性队列研究。我们将心血管事件定义为急性心力衰竭（AHF）、卒中和系统性栓塞（SSE）、急性冠状动脉综合征（ACS）和心源性猝死（SCD），心血管死亡定义为 AHF/SSE/ACS 相关死亡和 SCD。我们比较了接受房颤消融术（消融组）和仅接受药物治疗（药物组）的患者在 3 年内发生心血管事件和死亡的情况。
在使用 DOACs 的 782 例 NVAF 患者中，通过倾向评分匹配，每组各有 208 例患者。与药物组相比，消融组 3 年内心血管事件和死亡的发生率显著降低：心血管事件发生率分别为 24（13.2%）和 43（23.3%），log-rank = 0.009，风险比（HR）为 0.52（95%置信区间（CI）为 0.32-0.86）；心血管死亡率分别为 5（3.0%）和 15（7.8%），log-rank = 0.019，HR 为 0.32（95% CI 为 0.16-0.88）。
在使用 DOACs 的高龄 NVAF 患者中，与仅接受药物治疗的患者相比，接受房颤消融术的患者心血管事件和死亡的发生率更低。
