射血分数保留的心力衰竭患者行房颤导管消融术的疗效与安全性：一项系统评价和荟萃分析

Efficacy and safety of catheter ablation for atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis.

作者信息

Chen Xiaomei, Zhang Xuge, Fang Xiang, Feng Shenghong

机构信息

Department of Cardiology, Dazhou Second People's Hospital, Dazhou, China.

Department of Otorhinolaryngology Head and Neck Surgery, Dazhou Second People's Hospital, Dazhou, China.

出版信息

Front Cardiovasc Med. 2024 Jul 25;11:1423147. doi: 10.3389/fcvm.2024.1423147. eCollection 2024.

BACKGROUND

Catheter ablation (CA) effectively treats atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction (HFrEF), improving clinical outcomes. However, its benefits for AF patients with heart failure with preserved ejection fraction (HFpEF) are still unclear.

METHODS

We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus for studies investigating outcomes of CA in AF patients with HFpEF. Efficacy indicators included freedom from AF and antiarrhythmic drugs (AAD) free AF elimination. Safety indicators comprised total complications, HF admission, all-cause admission, and all-cause mortality. Sixteen studies with 20,796 patients included in our research.

RESULTS

The comprehensive analysis demonstrated that, when comparing CA with medical therapy in HFpEF, no significant differences were observed in terms of HF admissions, all-cause admissions, and all-cause mortality [(OR: 0.42; 95% CI: 0.12-1.51, = 0.19), (HR: 0.78; 95% CI: 0.48-1.27, = 0.31), and (OR: 1.10; 95% CI: 0.83-1.44, = 0.51)], while freedom from AF was significantly higher in CA (OR: 5.88; 95% CI: 2.99-11.54, < 0.00001). Compared with HFrEF, CA in HFpEF showed similar rates of freedom from AF, AAD-free AF elimination, total complications, and all-cause admission were similar [(OR:0.91; 95% CI: 0.71,1.17, =0.47), (OR: 0.97; 95% CI: 0.50-1.86, = 0.93), (OR: 1.27; 95% CI: 0.47-3.41, = 0.64), (OR: 1.11; 95% CI: 0.72, 1.73; = 0.63)]. However, CA in HFpEF was associated with lower rates of HF admission and all-cause mortality [(OR: 0.35; 95% CI: 0.20, 0.60; = 0.0002), (OR: 0.40; 95% CI: 0.18, 0.85; = 0.02)]. Compared with patients without HF, CA in HFpEF patients exhibited lower rates of AAD-free AF elimination (OR: 0.48; 95% CI: 0.30, 0.75; = 0.001). However, their rates of freedom from AF and total complications were similar [(OR: 0.70; 95% CI: 0.48, 1.02; = 0.06), (OR: 0.60; 95% CI: 0.19, 1.90; = 0.38)].

CONCLUSION

This meta-analysis conducted provided a comprehensive evaluation of the efficacy and safety of CA in patients with AF and HFpEF. The results suggest that CA may represent a valuable treatment strategy for patients with AF and HFpEF.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024514169).

背景

导管消融术（CA）可有效治疗射血分数降低的心力衰竭（HFrEF）患者的心房颤动（AF），改善临床结局。然而，其对射血分数保留的心力衰竭（HFpEF）的AF患者的益处仍不明确。

方法

我们系统检索了PubMed、Embase、Web of Science、Cochrane图书馆和Scopus，以查找研究CA治疗HFpEF的AF患者结局的研究。疗效指标包括无房颤和停用抗心律失常药物（AAD）后房颤消除。安全指标包括总并发症、因心力衰竭入院、全因入院和全因死亡率。我们的研究纳入了16项研究，共20796例患者。

结果

综合分析表明，在HFpEF患者中，将CA与药物治疗进行比较时，在因心力衰竭入院、全因入院和全因死亡率方面未观察到显著差异[（比值比：0.42；95%置信区间：0.12 - 1.51，P = 0.19），（风险比：0.78；95%置信区间：0.48 - 1.27，P = 0.31），以及（比值比：1.10；95%置信区间：0.83 - 1.44，P = 0.51）]，而CA组的无房颤率显著更高（比值比：5.88；95%置信区间：2.99 - 11.54，P < 0.00001）。与HFrEF相比，HFpEF患者的CA在无房颤率、停用AAD后房颤消除率、总并发症和全因入院方面相似[（比值比：0.91；95%置信区间：0.71, 1.17，P = 0.47），（比值比：0.97；95%置信区间：0.50 - 1.86，P = 0.93），（比值比：1.27；95%置信区间：0.47 - 3.41，P = 0.64），（比值比：1.11；95%置信区间：0.72, 1.73；P = 0.63）]。然而，HFpEF患者的CA与较低的因心力衰竭入院率和全因死亡率相关[（比值比：0.35；95%置信区间：0.20, 0.60；P = 0.0002），（比值比：0.40；95%置信区间：0.18, 0.85；P = 0.02）]。与无心力衰竭患者相比，HFpEF患者的CA停用AAD后房颤消除率较低（比值比：0.48；95%置信区间：0.30, 0.75；P = 0.001）。然而，他们的无房颤率和总并发症率相似[（比值比：0.70；95%置信区间：0.48, 1.02；P = 0.06），（比值比：0.60；95%置信区间：0.19, 1.90；P = 0.38）]。