Peng Xiaodong, Li Jiangtao, Liu Nian, He Liu, Liu Xiaoxia, Zhou Ning, Du Xin, Sang Caihua, Long Deyong, Dong Jianzeng, Ma Changsheng
Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Beijing, China.
Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Beijing, China.
Heart Rhythm. 2025 Sep;22(9):2209-2217. doi: 10.1016/j.hrthm.2024.10.029. Epub 2024 Oct 19.
The impact of comorbidity burden on outcomes of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in patients with heart failure and preserved ejection fraction (HFpEF) remains unclear.
The purpose of this study was to evaluate how comorbidity burden influences the association between RFCA and cardiovascular outcomes in AF patients with HFpEF.
AF patients with HFpEF from the prospective China-AF cohort, recruited between August 2011 and December 2020, were categorized into 2 groups based CHADS-VASc score: low comorbidity burden (score ≤4) and high comorbidity burden (score >4). The associations between RFCA and cardiovascular outcomes and interaction effects of comorbidity burden on these associations were assessed.
Among 1700 patients with median follow-up of 65.9 months, those in the low comorbidity burden group who received RFCA had a lower risk of composite events (cardiovascular death and ischemic stroke/transient ischemic attack [TIA]) (adjusted hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.21-0.59] and all-cause death (adjusted HR 0.31, 95% CI 0.17-0.54) compared to those without RFCA. However, significant associations were not observed in the high comorbidity burden group. The differences between low and high comorbidity burden groups were significant, with interaction effects noted between comorbidity burden and RFCA for cardiovascular death (P = 0.045) and ischemic stroke/TIA (P = 0.010). RFCA was associated with a reduced risk of AF recurrence in both comorbidity burden groups.
RFCA for AF is associated with reduced AF recurrence and improved cardiovascular outcomes in patients with HFpEF. However, these benefits may be limited for patients with a CHADS-VASc score >4 (high comorbidity burden).
合并症负担对射血分数保留的心力衰竭（HFpEF）患者房颤（AF）射频导管消融（RFCA）结局的影响尚不清楚。
本研究旨在评估合并症负担如何影响HFpEF的AF患者中RFCA与心血管结局之间的关联。
将2011年8月至2020年12月招募的前瞻性中国房颤队列中的HFpEF的AF患者根据CHADS-VASc评分分为两组：低合并症负担（评分≤4）和高合并症负担（评分>4）。评估RFCA与心血管结局之间的关联以及合并症负担对这些关联的交互作用。
在1700例患者中，中位随访65.9个月，低合并症负担组中接受RFCA的患者发生复合事件（心血管死亡和缺血性卒中/短暂性脑缺血发作[TIA]）的风险较低（校正风险比[HR]0.35，95%置信区间[CI]0.21-0.59），全因死亡风险也较低（校正HR 0.31，95%CI 0.17-0.54），而未接受RFCA的患者则不然。然而，在高合并症负担组中未观察到显著关联。低合并症负担组和高合并症负担组之间的差异显著，合并症负担与RFCA之间在心血管死亡（P = 0.045）和缺血性卒中/TIA（P = 0.010）方面存在交互作用。在两个合并症负担组中，RFCA均与房颤复发风险降低相关。
HFpEF患者的AF进行RFCA与房颤复发减少和心血管结局改善相关。然而，对于CHADS-VASc评分>4（高合并症负担）的患者，这些益处可能有限。
