Patel Harsh, Munshi Rezwan, Sheth Aakash, Agarwal Siddharth, Munoz Freddy Del-Carpio, Kowlgi Guru, DeSimone Christopher V, Labedi Mohamed Rafa, Dani Sourbha, Deshmukh Abhishek
Division of Cardiology, Southern Illinois University, Springfield, IL, USA.
Division of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA, USA.
J Interv Card Electrophysiol. 2024 Dec 23. doi: 10.1007/s10840-024-01939-z.
The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated.
This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction.
Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke.
In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group.
AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years.
导管消融作为同时患有心房颤动（AF）和射血分数保留的心力衰竭（HFpEF）患者的一种治疗方法，其疗效尚未得到充分研究。
本研究的目的是评估心房颤动消融（AFA）对射血分数保留的心力衰竭患者的有效性。
利用TriNetX研究网络，我们确定了2010年1月1日至2021年6月1日期间年龄在18岁及以上患有心房颤动（AF）并同时患有射血分数保留的心力衰竭（HFpEF）的个体。使用当前程序术语代码，根据患者的导管消融程序对患者进行进一步分类。在倾向评分匹配后，每个队列由9440名患者组成。主要终点是两年时的全因死亡率，次要结局是2年随访期间因心力衰竭、心房颤动和中风再次入院的情况。
在倾向匹配队列中，接受AFA加药物治疗的AF和HFpEF患者在两年时的全因死亡率显著低于未接受AFA的患者（风险比（HR）：0.37，95%置信区间：0.34 - 0.40；P < 0.001），即使在匹配抗心律失常药物后也是如此。在两年时，AFA组的次要结局包括心力衰竭再次入院（HR：0.86，95%置信区间：0.84 - 0.89；P < 0.001）和中风再次入院（HR：0.66，95%置信区间：0.59 - 0.73；P < 0.001）较低。
伴有HFpEF的AF患者进行AFA可显著降低全因死亡率。它还能在两年时显著减少因心力衰竭和缺血性中风导致的再次入院情况。
