Mahalleh Mehrdad, Soleimani Hamidreza, Pazoki Mohammadreza, Maleki Saba, Dastjerdi Parham, Ebrahimi Pouya, Zafarmandi Sahar, Khamene Sima Shamshiri, Khawajah Izat Mohammad, Tabassum Shehroze, Bhardwaj Rahul, Mattumpuram Jishanth, Kaplan Andrew, Vaseghi Marmar, Seilani Parisa, Bozorgi Ali, Hosseini Kaveh, Tzeis Stylianos
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Heart Fail Rev. 2025 Jan;30(1):1-15. doi: 10.1007/s10741-024-10437-3. Epub 2024 Sep 15.
The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).
PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.
Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.61; 95% CI, 0.43-0.85). The risk of HF hospitalization (HR 0.44; 95% CI, 0.23-0.83), cardiovascular mortality (HR 0.43; 95% CI, 0.22-0.84), and AF recurrence (HR 0.53; 95% CI, 0.39-0.73) were also lower in the CA group.
CA demonstrated significant cardiovascular morbidity and mortality benefits compared to SMT in the HFpEF population.
最新指南提倡对于射血分数降低的心力衰竭（HFrEF）患者，采用导管消融术（CA）而非标准药物治疗（SMT）来管理心房颤动（AF）。然而，关于CA与SMT在射血分数保留的心力衰竭（HFpEF）患者中的有效性，仍存在重大知识空白。
系统检索了截至2024年2月的PubMed、Scopus和Embase数据库。鉴于随机研究数量有限，还纳入了倾向评分匹配的观察性研究，比较HFpEF的AF患者中CA与SMT的疗效。主要结局是全因死亡率和心力衰竭住院的复合终点。
纳入了八项研究，共17717例接受SMT的患者和2537例接受CA的患者。CA与全因死亡率和心力衰竭住院复合终点的风险显著降低相关（风险比[HR] 0.61；95%置信区间[CI]，0.43 - 0.85）。CA组心力衰竭住院风险（HR 0.44；95% CI，0.23 - 0.83）、心血管死亡率（HR 0.43；95% CI，0.22 - 0.84）和房颤复发风险（HR 0.53；95% CI，0.39 - 0.73）也较低。
在HFpEF人群中，与SMT相比，CA显示出显著的心血管发病率和死亡率益处。
