Si Jinping, Ding Zijie, Chen Xuefu, Bai Lin, Sun Yuxi, Zhang Xinxin, Zhang Yanli, Xia Yunlong, Liu Ying
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 193 United Road, Dalian, 116021, Liaoning Province, China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Cardiovasc Drugs Ther. 2025 Feb;39(1):85-96. doi: 10.1007/s10557-023-07489-2. Epub 2023 Aug 30.
Previous studies investigating cardiac remodeling and functional regurgitation of rhythm control for atrial fibrillation (AF) in heart failure (HF) are limited. Therefore, this study aimed to evaluate the impact of rhythm control for AF on cardiac remodeling and functional regurgitation in the spectrum of HF. Its effect on prognosis was explored.
According to the treatment strategies of AF, the cohort was classified into the rhythm control and rate control groups. To further detect the implications of rhythm control on cardiac remodeling, functional regurgitation, and outcomes in HF subtypes, patients were further divided into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction, and HF with preserved ejection fraction (HFpEF) subgroups.
A total of 828 patients were enrolled, with 307 patients in the rhythm control group and 521 patients in the rate control group. Over a median follow-up time of 3.8 years, patients with rhythm control treatments experienced improvements in biatrial structure parameters, left ventricular ejection fraction, and functional regurgitation (mitral and tricuspid regurgitation) compared with rate control treatment (p < 0.05). Cox regression analysis demonstrated that rhythm control reduced the risks of all-cause mortality (HR 0.436 [95% CI, 0.218-0.871], p = 0.019) in HFpEF and HF-related admissions in HFrEF (HR 0.500 [95% CI, 0.330-0.757], p = 0.001) and HFpEF (HR 0.541 [95% CI, 0.407-0.720], p < 0.001); these associations were similar after adjusting for multiple confounders.
Rhythm control therapy can be considered an appropriate treatment strategy for the management of AF in HF to improve cardiac remodeling, functional regurgitation, and prognosis.
以往关于心力衰竭（HF）患者心房颤动（AF）节律控制对心脏重塑和功能性反流影响的研究有限。因此，本研究旨在评估AF节律控制对HF范围内心脏重塑和功能性反流的影响，并探讨其对预后的作用。
根据AF的治疗策略，将队列分为节律控制组和心率控制组。为进一步检测节律控制对HF亚型心脏重塑、功能性反流和结局的影响，患者进一步分为射血分数降低的HF（HFrEF）、射血分数轻度降低的HF和射血分数保留的HF（HFpEF）亚组。
共纳入828例患者，其中节律控制组307例，心率控制组521例。在中位随访时间3.8年期间，与心率控制治疗相比，接受节律控制治疗的患者在双房结构参数、左心室射血分数和功能性反流（二尖瓣和三尖瓣反流）方面有所改善（p < 0.05）。Cox回归分析表明，节律控制降低了HFpEF患者全因死亡率（HR 0.436 [95% CI，0.218 - 0.871]，p = 0.019）以及HFrEF患者（HR 0.500 [95% CI，0.330 - 0.757]，p = 0.001）和HFpEF患者（HR 0.541 [95% CI，0.407 - 0.720]，p < 0.001）因HF相关住院的风险；在调整多个混杂因素后，这些关联相似。
节律控制疗法可被视为HF患者AF管理的一种合适治疗策略，以改善心脏重塑、功能性反流和预后。
