心力衰竭患者心房颤动脉冲场消融的安全性和有效性：MANIFEST-PF亚组分析

Safety and Effectiveness of Pulsed Field Ablation for Atrial Fibrillation in Patients with Heart Failure: A MANIFEST-PF Sub-analysis.

作者信息

Turagam Mohit K, Neuzil Petr, Schmidt Boris, Reichlin Tobias, Neven Kars, Metzner Andreas, Hansen Jim, Blaauw Yuri, Maury Philippe, Arentz Thomas, Sommer Philipp, Anic Ante, Anselme Frederic, Boveda Serge, Deneke Tom, Willems Stephan, van der Voort Pepijn, Tilz Roland, Funasako Moritoshi, Scherr Daniel, Wakili Reza, Steven Daniel, Kautzner Josef, Vijgen Johan, Jais Pierre, Petru Jan, Chun Julian, Roten Laurent, Füting Anna, Lemoine Marc D, Ruwald Martin, Mulder Bart A, Rollin Anne, Lehrmann Heiko, Fink Thomas, Jurisic Zrinka, Chaumont Corentin, Adelino Raquel, Nentwich Karin, Gunawardene Melanie, Ouss Alexandre, Heeger Christian-Hendrik, Manninger Martin, Bohnen Jan-Eric, Sultan Arian, Peichl Petr, Koopman Pieter, Derval Nicolas, Kueffer Thomas, Reinsch Nico, Reddy Vivek Y

机构信息

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia.

出版信息

JACC Clin Electrophysiol. 2024 May 8. doi: 10.1016/j.jacep.2024.05.002.

DOI:10.1016/j.jacep.2024.05.002

PMID:38869506

Abstract

BACKGROUND

Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).

OBJECTIVE

To assess the outcomes of pulsed-field ablation (PFA) in HF.

METHODS

MANIFEST-PF is a multicenter patient-level registry of consecutive patients undergoing PFA for paroxysmal (PAF) or persistent AF (PerAF). In this sub-study, patients were stratified as: no history of HF (no-HF), HF with preserved EF (HFEF; LVEF≥50%) or HF with reduced/mildly-reduced EF (HFEF; LVEF<50%). The primary effectiveness and safety endpoints were freedom from documented atrial arrhythmias lasting ≥30s and major adverse events (MAEs), respectively.

RESULTS

Of the 1,381 patients, 85% (n=1,174) were no-HF, 6.2% (n=87) were HFEF, and 8.6% (n=120) were HFEF. No-HF patients had less PerAF than patients with HF (p<0.001), with no difference between HF subtypes (p=1.00). The 1-year freedom from atrial arrhythmia was significantly higher in no-HF than with HFEF or HFEF (79.9%, 71.3%, 67.5%, p<0.001), but similar between HFEF and HFEF (p=0.26). However, there was no significant difference in freedom from atrial arrhythmia among patients with no-HF vs HFEF vs HFEF for those with PAF (82.8%/82.4%/71.7%, p=0.09) and PerAF (73.3%, 64.2%, and 64.9%, p=0.14.MAE rates were similar between the no-HF, HFEF and HFEF groups (1.9%, 0%, and 2.5%, respectively).

CONCLUSION

PFA appears to be potentially safe and effective in AF patients with HF. Freedom from atrial arrhythmia post-PFA was higher in patients without a history of HF, with no significant difference between HF subtypes.

摘要

背景

心房颤动（AF）与心力衰竭（HF）共存，会增加发病率和死亡率。研究表明，射血分数降低（EF）的HF患者进行AF消融术后预后得到改善。

目的

评估脉冲场消融（PFA）治疗HF的疗效。

方法

MANIFEST-PF是一项多中心患者水平注册研究，纳入连续接受PFA治疗阵发性（PAF）或持续性AF（PerAF）的患者。在这项子研究中，患者被分层为：无HF病史（无HF）、射血分数保留的HF（HFEF；左心室射血分数[LVEF]≥50%）或射血分数降低/轻度降低的HF（HFrEF；LVEF<50%）。主要有效性和安全性终点分别为无持续≥30秒的记录在案的房性心律失常和主要不良事件（MAE）。

结果

1381例患者中，85%（n=1174）为无HF，6.2%（n=87）为HFEF，8.6%（n=120）为HFrEF。无HF患者的PerAF少于HF患者（p<0.001），HF各亚型之间无差异（p=1.00）。无HF患者1年无房性心律失常的比例显著高于HFEF或HFrEF患者（79.9%、71.3%、67.5%，p<0.001），但HFEF和HFrEF之间相似（p=0.26）。然而，对于PAF患者（82.8%/82.4%/71.7%，p=0.09）和PerAF患者（73.3%、64.2%和64.9%，p=0.14），无HF、HFEF和HFrEF患者在无房性心律失常方面无显著差异。无HF、HFEF和HFrEF组的MAE发生率相似（分别为1.9%、0%和2.5%）。