Department of Cardiovascular Medicine (A.Y., C.T., H.N., P.B., D.O.M., S.N., M.K., J. Sroubek, J.Z.L.), Cleveland Clinic, OH.
Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute (P.S., A.H.E.H., W.I.S., O.M.W., A.A.H.), Cleveland Clinic, OH.
Circ Arrhythm Electrophysiol. 2024 Sep;17(9):e012926. doi: 10.1161/CIRCEP.124.012926. Epub 2024 Aug 28.
Catheter ablation (CA) improves clinical outcomes in patients with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to evaluate the impact of CA on clinical and quality-of-life outcomes across HF subtypes.
All patients undergoing AF ablation at a tertiary center were enrolled in a prospective registry and included in this study (2013-2021). The primary end point was AF recurrence. Secondary end points included AF-related hospitalizations and quality-of-life outcomes. Patients were categorized according to their HF status: no HF, HFrEF, HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF).
A total of 7020 patients were included (80% no HF, 8% HFrEF, 7% HFmrEF, and 5% HFpEF). Over 3 years, the cumulative incidence of AF recurrence after ablation was as follows: HFpEF (53%), HFmrEF (41%), HFrEF (41%), and no HF (34%); <0.01. Multivariable Cox analyses confirmed these findings using no HF group as reference (HFpEF: hazard ratio, 1.47 [95% CI, 1.21-1.78]; HFmrEF: hazard ratio, 1.23 [95% CI, 1.04-1.45]; and HFrEF: hazard ratio, 1.17 [95% CI, 1.01-1.37]; <0.05 for all). In all groups, CA resulted in a significant reduction of AF-related hospitalization (mean rate per 1 patient-years [before and after CA]; HFpEF [1.8 versus 0.3], HFmrEF [1.1 versus 0.2], HFrEF [1.1 versus 0.2], and no HF [1 versus 0.1]; <0.01 for each comparison) and significant improvement in quality of life as measured by both the AF symptom severity score and the AF burden score (<0.01 for the comparison between baseline and follow-up for each score when tested separately).
AF recurrence rates after CA were higher in patients with HF compared with those without HF, with patients with HFpEF being at the highest risk of recurrence. Nonetheless, CA was associated with a significant reduction in AF symptoms, AF-related hospitalization, and HF symptoms in most patients irrespective of HF subtypes.
导管消融（CA）可改善射血分数降低的心力衰竭（HFrEF）合并心房颤动（AF）患者的临床结局。我们旨在评估 CA 对各种心力衰竭亚型的临床和生活质量结局的影响。
在一个三级中心进行 AF 消融的所有患者均被纳入前瞻性注册研究，并纳入本研究（2013-2021 年）。主要终点是 AF 复发。次要终点包括 AF 相关住院和生活质量结局。根据 HF 状态对患者进行分类：无 HF、HFrEF、射血分数轻度降低的 HF（HFmrEF）和射血分数保留的 HF（HFpEF）。
共纳入 7020 例患者（80%无 HF、8% HFrEF、7% HFmrEF 和 5% HFpEF）。消融后 3 年 AF 复发的累积发生率如下：HFpEF（53%）、HFmrEF（41%）、HFrEF（41%）和无 HF（34%）；<0.01。多变量 Cox 分析使用无 HF 组作为参考证实了这些发现（HFpEF：风险比，1.47[95%CI，1.21-1.78]；HFmrEF：风险比，1.23[95%CI，1.04-1.45]；HFrEF：风险比，1.17[95%CI，1.01-1.37]；均<0.05）。在所有组中，CA 均显著降低了 AF 相关住院率（每 1 例患者年的平均发生率[CA 前后]；HFpEF[1.8 比 0.3]、HFmrEF[1.1 比 0.2]、HFrEF[1.1 比 0.2]和无 HF[1 比 0.1]；每个比较均<0.01），并显著改善了生活质量，这一点通过 AF 症状严重程度评分和 AF 负担评分均得到证实（当单独测试时，每个评分的基线与随访之间的比较均<0.01）。
与无 HF 患者相比，HF 患者 CA 后的 AF 复发率更高，HFpEF 患者的复发风险最高。然而，在大多数患者中，CA 与 AF 症状、AF 相关住院和 HF 症状的显著减少相关，无论 HF 亚型如何。
