房室结消融术是肥厚型心肌病合并心房颤动患者的有效治疗策略。

Atrioventricular nodal ablation is an effective management strategy for atrial fibrillation in patients with hypertrophic cardiomyopathy.

机构信息

Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.

University College London Medical School, London, United Kingdom.

出版信息

Heart Rhythm. 2023 Dec;20(12):1606-1614. doi: 10.1016/j.hrthm.2023.08.028. Epub 2023 Aug 24.

DOI:10.1016/j.hrthm.2023.08.028

PMID:37633429

Abstract

BACKGROUND

Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and can be challenging to manage. Atrioventricular nodal (AVN) ablation may be an effective management strategy for AF in these patients.

OBJECTIVE

The purpose of this study was to assess the efficacy of AVN ablation in HCM patients who have failed medical therapy and/or catheter ablation for AF.

METHODS

A multicenter study with retrospective analysis of a prospectively collated HCM registry was performed. AVN ablation patients were identified. Baseline characteristics and device and procedural indications were collected. Symptoms defined by New York Heart Association and European Heart Rhythm Association classification and echocardiographic findings during follow-up were assessed.

RESULTS

Fifty-nine patients were included in the study. Indications for AVN ablation were 6 (10.2%) inappropriate implantable cardioverter-defibrillator shock, 35 (59.3%) ineffective rate control, and 18 (30.5%) to regularize rhythm for symptom improvement. During post-AVN ablation follow-up of 79.4 ± 61.1 months, left ventricular ejection fraction (LVEF) remained stable (pre-LVEF 48.9% ± 12.6% vs post-LVEF 50.1% ± 10.1%; P = .29), even in those without a cardiac resynchronization therapy (CRT) device (pre-LVEF 54.3% ± 8.0% vs post-LVEF 53.8% ± 8.0%; P = .65). Forty-nine patients (83.1%) reported an improvement in symptoms regardless of AF type (17/21 [81.0%] paroxysmal vs 32/38 [84.2%] persistent; P = 1.00), presence of baseline left ventricular impairment (22/26 [84.6%] LVEF ≤50% vs 27/33 [81.8%] LVEF ≥50%; P = 1.00) or CRT device (27/32 [84.4%] CRT vs 22/27 [81.5%] no CRT; P = 1.00). Symptoms improved in 16 patients (89.0%) who underwent AVN ablation to regularize rhythm.

CONCLUSION

AVN ablation improved symptoms without impacting left ventricular function in the majority of patients. The data suggest that AVN ablation is an effective and safe management approach for AF in HCM and should be further evaluated in larger prospective studies.

摘要

背景

心房颤动（AF）在肥厚型心肌病（HCM）患者中很常见，且难以治疗。房室结（AVN）消融可能是这些患者 AF 的有效治疗策略。

目的

本研究旨在评估 AVN 消融对因 AF 而接受药物治疗和/或导管消融失败的 HCM 患者的疗效。

方法

采用回顾性分析前瞻性收集的 HCM 登记处的多中心研究。确定了接受 AVN 消融的患者。收集了基线特征以及器械和程序适应证。评估了根据纽约心脏协会和欧洲心律协会分类定义的症状以及随访期间的超声心动图发现。

结果

研究纳入了 59 例患者。AVN 消融的适应证为 6 例（10.2%）不合适的植入式心律转复除颤器电击、35 例（59.3%）无效的心率控制和 18 例（30.5%）为改善症状而使节律正常化。在 AVN 消融后 79.4±61.1 个月的随访期间，左心室射血分数（LVEF）保持稳定（消融前 LVEF 为 48.9%±12.6%，消融后 LVEF 为 50.1%±10.1%；P=0.29），即使在没有心脏再同步治疗（CRT）装置的患者中也是如此（消融前 LVEF 为 54.3%±8.0%，消融后 LVEF 为 53.8%±8.0%；P=0.65）。49 例患者（83.1%）无论 AF 类型如何（17/21[81.0%]阵发性 vs.32/38[84.2%]持续性；P=1.00）、是否存在基线左心室功能障碍（22/26[84.6%]LVEF≤50% vs.27/33[81.8%]LVEF≥50%；P=1.00）或 CRT 装置（27/32[84.4%]CRT vs.22/27[81.5%]无 CRT；P=1.00）均报告症状改善。16 例（89.0%）因节律正常化而接受 AVN 消融的患者症状改善。