Siow Yoon-Kee, Lin Chin-Yu, Chung Fa-Po, Lin Yenn-Jiang, Chang Shih-Lin, Lo Li-Wei, Hu Yu-Feng, Liao Jo-Nan, Chang Ting-Yung, Tuan Ta-Chuan, Kuo Ling, Wu Cheng-I, Liu Chih-Min, Liu Shin-Huei, Li Guan-Yi, Kuo Ming-Jen, Wu Shang-Ju, Bautista Jose Antonio, Huang Yu-Shan, Nguyen Dinh Son Ngoc, Chen Shih-Ann
Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Cardiology, Serdang Hospital, Selangor, Malaysia.
Front Cardiovasc Med. 2024 Jan 16;11:1305485. doi: 10.3389/fcvm.2024.1305485. eCollection 2024.
Catheter ablation is an effective and safe strategy for treating atrial fibrillation patients. Nevertheless, studies on the long-term outcomes of catheter ablation in patients with dilated cardiomyopathy are limited. This study aimed to assess the electrophysiological characteristics of atrial fibrillation patients with dilated cardiomyopathy and compare the long-term clinical outcomes between patients undergoing catheter ablation and medical therapy.
Patient baseline characteristics and electrophysiological parameters were examined to identify the predictors of atrial fibrillation recurrence following catheter ablation. The clinical outcomes of catheter ablation and medical therapy were compared using the propensity score matched method.
A total of 343 patients were enrolled, with 46 in the catheter ablation group and 297 in the medical therapy group. Among the catheter ablation group, 58.7% ( = 27) had persistent atrial fibrillation. The recurrence rate of atrial arrhythmia was 30.4% ( = 14) after an average follow-up duration of 7.7 years following catheter ablation. The only predictive factor for atrial fibrillation recurrence after catheter ablation was the left atrial diameter. When compared to medical therapy, catheter ablation demonstrated significantly better outcomes in terms of overall survival, freedom from heart failure hospitalization, improvement in left ventricular ejection fraction, and a greater reduction in left ventricular diameter and left atrial diameter after propensity score matching.
Therefore, catheter ablation proves to be effective in providing long-term control of atrial fibrillation in patients with dilated cardiomyopathy. In addition to standard heart failure care, catheter ablation significantly enhanced both morbidity and mortality outcomes and reversed structural remodeling when compared to heart failure medication alone.
导管消融是治疗心房颤动患者的一种有效且安全的策略。然而，关于扩张型心肌病患者导管消融长期预后的研究有限。本研究旨在评估扩张型心肌病合并心房颤动患者的电生理特征，并比较接受导管消融和药物治疗患者的长期临床结局。
检查患者的基线特征和电生理参数，以确定导管消融术后心房颤动复发的预测因素。采用倾向评分匹配法比较导管消融和药物治疗的临床结局。
共纳入343例患者，其中导管消融组46例，药物治疗组297例。导管消融组中，58.7%（n = 27）为持续性心房颤动。导管消融术后平均随访7.7年，房性心律失常复发率为30.4%（n = 14）。导管消融术后心房颤动复发的唯一预测因素是左心房直径。倾向评分匹配后，与药物治疗相比，导管消融在总生存率、免于心力衰竭住院、左心室射血分数改善以及左心室直径和左心房直径更大程度缩小方面显示出明显更好的结局。
因此，导管消融被证明对扩张型心肌病患者的心房颤动具有长期控制作用。除了标准的心力衰竭治疗外，与单独使用心力衰竭药物相比，导管消融显著改善了发病率和死亡率结局，并逆转了结构重塑。
