Maidman Samuel D, Aizer Anthony, Jankelson Lior, Holmes Douglas, Park David S, Bernstein Scott A, Knotts Robert, Kushnir Alex, Chinitz Larry A, Barbhaiya Chirag R
Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, 403 E 34Th Street, 4Th Floor, New York, NY, 10016, USA.
J Interv Card Electrophysiol. 2025 Jun;68(4):857-864. doi: 10.1007/s10840-024-01965-x. Epub 2024 Dec 19.
Recent evidence suggests atrial fibrillation (AF) causes cardiomyopathy due to remodeling driven by both irregular rate and rhythm. Atrial fibrillation (AF) ablation in patients with reduced ejection fraction (EF) ≤ 35% has been shown to improve EF and mortality. It is unknown whether the benefits of AF ablation among patients with reduced EF are affected by the degree of pre-ablation rate control.
To evaluate AF ablation echocardiographic outcomes for patients who have EF ≤ 35% with varying degrees of pre-ablation rate control.
Single-center, retrospective study of patients with EF ≤ 35% undergoing first-time ablation of persistent AF. Primary analyses evaluated the degree to which pre-ablation rate control impacted echocardiographic outcomes. Rates of EF recovery to > 35% were compared at three different cutoffs: 110 bpm, 90 bpm, and 70 bpm. A linear regression analysis was then performed to evaluate whether baseline heart rate (HR) predicted change in EF.
Among 73 patients, the mean pre-ablation resting HR was 90 ± 25 bpm, and baseline EF was 27 ± 7%. Patients experienced significant improvements in EF by mean + 14% ± 11% (p < 0.001). Post-ablation EF recovery occurred in 60% of patients. No differences in EF improvement were detected at HR control targets of ≤ 110 bpm or ≤ 90 bpm, while patients achieving HR ≤ 70 bpm had less improvement in EF (+ 9% ± 9%) compared to those with HR above the cutoff (+ 16% ± 11%; p = 0.01). Linear regression analysis did not reveal baseline HR as a significant predictor of change in LVEF (slope = 0.09, r = 0.05, p = 0.07).
Catheter ablation of persistent AF in patients with reduced EF frequently resulted in recovery in EF > 35%, irrespective of pre-ablation achieved rate control. While patients with HR > 70 bpm experienced a greater improvement in EF compared to those ≤ 70 bpm, patients with baseline HR below this target still experienced significant EF improvements. Further investigation into irregularity-mediated cardiomyopathy is warranted.
最近的证据表明，心房颤动（AF）由于不规则的心率和节律驱动的重塑而导致心肌病。射血分数（EF）≤35%的患者进行心房颤动（AF）消融已被证明可改善EF和降低死亡率。尚不清楚EF降低的患者中AF消融的益处是否受消融前心率控制程度的影响。
评估EF≤35%且消融前心率控制程度不同的患者的AF消融超声心动图结果。
对EF≤35%且首次进行持续性AF消融的患者进行单中心回顾性研究。主要分析评估消融前心率控制对超声心动图结果的影响程度。在三个不同的心率临界值（110次/分、90次/分和70次/分）下比较EF恢复至>35%的比率。然后进行线性回归分析，以评估基线心率（HR）是否可预测EF的变化。
73例患者中，消融前静息HR平均为90±25次/分，基线EF为27±7%。患者的EF平均显著改善了+14%±11%（p<0.001）。60%的患者消融后EF恢复。在心率控制目标≤110次/分或≤90次/分的情况下，未检测到EF改善的差异，而心率≤70次/分的患者与心率高于临界值的患者相比，EF改善较少（+9%±9%）（+16%±11%；p=0.01）。线性回归分析未显示基线HR是左心室射血分数（LVEF）变化的显著预测因素（斜率=0.09，r=0.05，p=0.07）。
EF降低的患者进行持续性AF导管消融通常会使EF恢复至>35%，无论消融前的心率控制情况如何。虽然心率>70次/分的患者与心率≤70次/分的患者相比，EF改善更大，但基线心率低于该目标的患者EF仍有显著改善。有必要对不规则介导的心肌病进行进一步研究。
