Shamaki Garba Rimamskep, Neppala Siva, Hidri Sinda, Hotwani Priya, Aldabagh Mohammed, Aziz Sundal, Upreti Prakash, Seri Amith, Kumanayaka Dilesha Dilangi, Oloyede Ebenezer, Sattar Yasar
Tower Health Reading Hospital, West Reading PA, United States of America.
Department of Medicine, University of Texas, San Antonio TX, United States of America.
Curr Probl Cardiol. 2025 Mar;50(3):102953. doi: 10.1016/j.cpcardiol.2024.102953. Epub 2024 Dec 2.
Atrial fibrillation has been linked with poor outcomes in patients with cardiac amyloidosis. We evaluate the in-hospital outcomes of patients with atrial fibrillation and concomitant cardiac amyloidosis with and without catheter ablation.
The National Inpatient Sample databases (2016 to 2021) were queried to identify patients admitted with atrial fibrillation and concomitant cardiac amyloidosis using ICD 10 codes. The study population aged >18 years was divided into two cohorts; ablation (AB) vs. no ablation (NAB). Multivariate logistic regression model adjusting for baseline characteristics and comorbidities. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were acute heart failure, cardiogenic shock, ventricular fibrillation, major bleeding, stroke, length of stay, and hospitalization cost.
73,160 patients were identified. 595(0.8 %) underwent ablation and 72,656 (99.2 %) did not. Both NAB and AB patients were predominantly white (69.6 % and 60.3 %) respectively. AB patients were younger with median age [74 years (IQR 66-80) vs. 78 years (IQR 71-84), p < 0.01], compared with NAB patients. AB patients were more likely to have heart failure (76.5 % vs. 65.3 %, p = 0.04), and have a family history of CAD (11.1 % vs. 4.8 %, p = 0.03). Contrarily, NAB patients were more likely to have dementia (11.5 % vs. 2.5 %, p = 0.01). After adjusting for baseline characteristics and comorbidity, there was no difference in all-cause mortality (OR 0.3, CI 0.08-1.35, p = 0.12), stroke (OR 1.1, CI 0.4-2.8, p = 0.87), or major bleeding (OR 1.4, CI 0.7-2.6, p = 0.37). Undergoing ablation was associated with higher odds of acute heart failure (OR 1.9, CI 1.1-3.3, p<0.01). After adjusting for inflation using the consumer price index, adjusted total cost of hospitalization was for higher AB patients was compared to NAB patients ($41,499.22 vs. $13,085.11) with a significantly longer length of stay among AB patients (7 days vs. 5days, p < 0.01).
Atrial fibrillation and concomitant cardiac amyloidosis in patients undergoing catheter ablation are associated with an increased risk of acute heart failure, higher cost, and a longer length of stay.
心房颤动与心脏淀粉样变性患者的不良预后相关。我们评估了伴有和不伴有导管消融的心房颤动合并心脏淀粉样变性患者的院内结局。
查询国家住院患者样本数据库（2016年至2021年），使用国际疾病分类第10版代码识别患有心房颤动并伴有心脏淀粉样变性的患者。年龄>18岁的研究人群分为两个队列；消融组（AB）与非消融组（NAB）。采用多变量逻辑回归模型对基线特征和合并症进行调整。主要结局是全因院内死亡率。次要结局包括急性心力衰竭、心源性休克、心室颤动、大出血、中风、住院时间和住院费用。
共识别出73160例患者。595例（0.8%）接受了消融，72656例（99.2%）未接受消融。NAB组和AB组患者主要为白人，分别占69.6%和60.3%。与NAB组患者相比，AB组患者更年轻，中位年龄分别为74岁（四分位间距66 - 80岁）和78岁（四分位间距71 - 84岁），p<0.01。AB组患者更易发生心力衰竭（76.5%对65.3%，p = 0.04），且有冠心病家族史的比例更高（11.1%对4.8%，p = 0.03）。相反，NAB组患者更易患痴呆（11.5%对2.5%，p = 0.01）。在对基线特征和合并症进行调整后，全因死亡率（比值比0.3，可信区间0.08 - 1.35，p = 0.12）、中风（比值比1.1，可信区间0.4 - 2.8，p = 0.87）或大出血（比值比1.4，可信区间0.7 - 2.6，p = 0.37）无差异。接受消融与急性心力衰竭的较高发生率相关（比值比1.9，可信区间1.1 - 3.3，p<0.01）。使用消费者价格指数对通货膨胀进行调整后，AB组患者的调整后住院总费用高于NAB组患者（41499.22美元对13085.11美元），且AB组患者的住院时间明显更长（7天对5天，p<0.01）。
接受导管消融的心房颤动合并心脏淀粉样变性患者发生急性心力衰竭的风险增加、费用更高且住院时间更长。
