Ando Monami, Yanagisawa Satoshi, Suzuki Hirohiko, Yoshida Yukihiko, Kanzaki Yasunori, Morishima Itsuro, Ishikawa Shinji, Kamikubo Yosuke, Okumura Satoshi, Kato Hiroyuki, Mizutani Yoshiaki, Murase Yosuke, Nakasuka Kosuke, Warita Shunichiro, Sekimoto Satoru, Takemoto Yoshio, Takasugi Nobuhiro, Ohguchi Shiou, Senga Michiharu, Yokoi Kenichiro, Watanabe Ryo, Ogura Yasuhiro, Shibata Rei, Inden Yasuya, Murohara Toyoaki
Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
JACC Asia. 2024 Sep 24;4(11):857-871. doi: 10.1016/j.jacasi.2024.08.005. eCollection 2024 Nov.
Atrial fibrillation (AF) and heart failure (HF) often coexist, leading to increased mortality. A cryoballoon-based approach is a potential treatment for patients with HF because of its safety and efficacy.
The authors sought to evaluate the optimal timing of cryoballoon ablation after the first clinical diagnosis of AF and its prognosis for patients with HF.
This large-scale multicenter study retrospectively collected data of patients with HF who underwent cryoballoon ablation for AF from 17 Japanese institutions. Patients were divided into 2 groups depending on the duration between the first diagnosis and ablation using a median time of 0.5 year (IQR: 0.3-2.0 years). Clinical endpoints of recurrence, mortality, and HF hospitalization were compared between the 2 groups.
Among 3,655 patients, 543 with HF were included for analysis. During a median follow-up period of 21.3 months (IQR: 12.0-36.8 months), 151 of 520 patients (29%) had a recurrence. The AF recurrence rate was significantly lower in the early-ablation group (≤0.5 year) than in the delayed-ablation group (>0.5 year) (24% [65/266] vs 34% [86/254], respectively; = 0.018). In the multivariable analysis, early ablation ≤ 0.5 year was independently associated with an absence of recurrence (HR: 0.581; 95% CI: 0.401-0.842; = 0.004). Delayed time for cryoballoon ablation incrementally increased the risk of postablation recurrence. Antiarrhythmic drug use was independently associated with delayed ablation. No significant differences in mortality or HF hospitalization were observed between the 2 groups.
Early cryoablation reduced the risk of recurrence in patients with HF, which may help improve clinical management.
心房颤动（AF）与心力衰竭（HF）常并存，导致死亡率增加。基于冷冻球囊的治疗方法因其安全性和有效性，是HF患者的一种潜在治疗手段。
作者试图评估首次临床诊断AF后冷冻球囊消融的最佳时机及其对HF患者的预后。
这项大规模多中心研究回顾性收集了来自17家日本机构的因AF接受冷冻球囊消融的HF患者的数据。根据首次诊断与消融之间的持续时间，以0.5年的中位数时间（四分位间距：0.3 - 2.0年）将患者分为两组。比较两组的复发、死亡率和HF住院等临床终点。
在3655例患者中，纳入543例HF患者进行分析。在中位随访期21.3个月（四分位间距：12.0 - 36.8个月）内，520例患者中有151例（29%）复发。早期消融组（≤0.5年）的AF复发率显著低于延迟消融组（>0.5年）（分别为24%[65/266]和34%[86/254]；P = 0.018）。在多变量分析中，≤0.5年的早期消融与无复发独立相关（风险比：0.581；95%置信区间：0.401 - 0.842；P = 0.004）。冷冻球囊消融延迟时间会逐渐增加消融后复发风险。抗心律失常药物的使用与延迟消融独立相关。两组在死亡率或HF住院方面未观察到显著差异。
早期冷冻消融降低了HF患者的复发风险，这可能有助于改善临床管理。
