Eysenck William, Sulke Neil, Patel Nikhil, Furniss Stephen, Veasey Rick, Freemantle Nick, Bodagh Neil
Consultant Cardiologist.
Consultant Cardiologist Eastbourne General Hospital, Kings Drive, Eastbourne, East Sussex, BN21 2UD.
Br J Cardiol. 2024 Apr 16;31(2):014. doi: 10.5837/bjc.2024.014. eCollection 2024.
Our objective was to compare the efficacy of atrial fibrillation (AF) ablation versus permanent pacemaker (PPM) with atrioventricular node ablation (AVNA) versus direct current cardioversion (DCCV) for persistent AF in patients ≥65 years old. Seventy-seven patients (aged 66-86, mean 75.4 years) with persistent AF were randomised (1:1:1) to AF ablation + amiodarone (± DCCV), PPM with AVNA (+DCCV) or DCCV + amiodarone. The primary end point was persistent AF recurrence, measured with an implanted cardiac monitor or PPM. Cardiopulmonary exercise testing (CPET) was performed at baseline and six months. Symptom questionnaires were completed monthly. Follow-up was 12 months. The primary end point occurred in fewer patients following AF ablation + amiodarone than DCCV + amiodarone (seven patients, 28% 15 patients, 60%; hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.293 to 1.065, p=0.073) with no differences between DCCV + amiodarone and PPM with AVNA (HR 0.990, 95%CI 0.539 to 1.818, p=0.973). AF ablation + amiodarone resulted in a lower AF burden at 12 months compared with DCCV + amiodarone (17.0 ± 37.9% vs. 61.7 ± 48.6%, p<0.0001). Modified European Heart Rhythm Association (EHRA) symptom class improved in all patients (baseline 2.4 ± 0.495 12-month follow-up 1.84 ± 0.081, p=0.00001). Six-month CPET demonstrated a higher VO peak in sinus rhythm (SR) compared with baseline in AF (12.1 ± 4.2 ml/kg/min at baseline to 15.3 ± 4.2 ml/kg/min at six months, p=0.013). In conclusion, in older patients with persistent AF, ablation + amiodarone resulted in a lower AF burden at 12 months than DCCV + amiodarone. There was a non-significant trend toward reduced recurrence of devicedetected persistent AF episodes. All therapies improved symptoms despite DCCV restoring SR in <50% of patients at 12 months. CPET demonstrated improved VO peak with SR restoration.
我们的目标是比较房颤（AF）消融术与永久起搏器（PPM）联合房室结消融术（AVNA）以及直流电复律（DCCV）对≥65岁持续性房颤患者的疗效。77例持续性房颤患者（年龄66 - 86岁，平均75.4岁）被随机分为三组（1:1:1），分别接受房颤消融 + 胺碘酮（± DCCV）、PPM联合AVNA（+DCCV）或DCCV + 胺碘酮治疗。主要终点是通过植入式心脏监测仪或PPM测量的持续性房颤复发情况。在基线和6个月时进行心肺运动试验（CPET）。每月完成症状问卷。随访12个月。与DCCV + 胺碘酮组相比，房颤消融 + 胺碘酮组发生主要终点的患者较少（7例，28% 对15例，60%；风险比[HR] 0.559，95%置信区间[CI] 0.293至1.065，p = 0.073），DCCV + 胺碘酮组与PPM联合AVNA组之间无差异（HR 0.990，95%CI 0.539至1.818，p = 0.973）。与DCCV + 胺碘酮组相比，房颤消融 + 胺碘酮组在12个月时房颤负荷更低（17.0 ± 37.9% 对61.7 ± 48.6%，p < 0.0001）。所有患者改良后的欧洲心律协会（EHRA）症状分级均有所改善（基线2.4 ± 0.495 对12个月随访时1.84 ± 0.081，p = 0.00001）。6个月时的CPET显示，与房颤基线时相比，窦性心律（SR）时的峰值摄氧量更高（基线时为12.1 ± 4.2 ml/kg/min，6个月时为15.3 ± 4.2 ml/kg/min，p = 0.013）。总之，在老年持续性房颤患者中，消融 + 胺碘酮在12个月时的房颤负荷低于DCCV + 胺碘酮。在减少设备检测到的持续性房颤发作复发方面存在不显著的趋势。尽管12个月时DCCV使<50%的患者恢复窦性心律，但所有治疗方法均改善了症状。CPET显示随着窦性心律恢复，峰值摄氧量有所改善。
