Hashem Carl, Joseph Jacob, Kinlay Scott, Peralta Adelqui O, Hoffmeister Peter S, Yuyun Matthew F
Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Division of Cardiology, VA Providence Healthcare System, Providence, RI, USA.
Cardiol Res. 2025 Feb;16(1):33-43. doi: 10.14740/cr2020. Epub 2025 Jan 21.
Previous studies have provided evidence of reduced recurrence of atrial fibrillation (AF), all-cause mortality, and heart failure (HF) hospitalizations after catheter ablation (CA) in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the efficacy of AF ablation and clinical endpoints in HF with mildly reduced ejection fraction (HFmrEF) to HFrEF and HFpEF are lacking.
We conducted a systematic review and meta-analysis aimed at determining any differences in AF recurrence rate, all-cause mortality, and HF hospitalizations among patients with HFrEF, HFmrEF, and HFpEF who underwent AF ablation. A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library databases was performed until October 31, 2023.
A total of seven studies comprising 3,795 patients were retained: HFrEF 1,281 (33.8%), HFmrEF 870 (22.9%), and HFpEF 1,644 (43.3%). After median follow-up of 24 months, there was no significant difference in rate of AF recurrence between the three HF categories: HFrEF 40% (30-49%), HFmrEF 35% (28-43%); and HFpEF 35% (25-45%). Only two studies which included outcomes in the three HF categories were identified. Pooled hazard ratio (HR) of all-cause mortality and HF hospitalization combined after ablation or other rhythm control compared to other conservative management were: HFrEF 0.77 (0.63 - 0.94); HFmrEF 0.81 (0.55 - 1.20); and HFpEF 0.74 (0.55 - 1.00).
CA has similar efficacy in the long-term resolution of AF among patients with HFrEF, HFmrEF, and HFpEF. Further studies are needed to provide a robust analysis on the potential impact of CA on all-cause mortality.
既往研究已证实，在射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）患者中，导管消融（CA）术后心房颤动（AF）复发率、全因死亡率及心力衰竭（HF）住院率均有所降低。目前尚缺乏比较AF消融术在射血分数轻度降低的心力衰竭（HFmrEF）与HFrEF和HFpEF患者中的疗效及临床终点的汇总数据。
我们进行了一项系统评价和荟萃分析，旨在确定接受AF消融术的HFrEF、HFmrEF和HFpEF患者在AF复发率、全因死亡率和HF住院率方面是否存在差异。对PubMed/MEDLINE、Embase和Cochrane图书馆数据库进行了系统检索，直至2023年10月31日。
共纳入7项研究，3795例患者：HFrEF 1281例（33.8%），HFmrEF 870例（22.9%），HFpEF 1644例（43.3%）。中位随访24个月后，三种HF类型之间的AF复发率无显著差异：HFrEF为40%（30 - 49%），HFmrEF为35%（28 - 43%）；HFpEF为35%（25 - 45%）。仅两项研究纳入了三种HF类型的结局。与其他保守治疗相比，消融或其他节律控制后全因死亡率和HF住院率合并的汇总风险比（HR）为：HFrEF 0.77（0.63 - 0.94）；HFmrEF 0.81（0.55 - 1.20）；HFpEF 0.74（0.55 - 1.00）。
CA在HFrEF、HFmrEF和HFpEF患者的AF长期缓解方面具有相似的疗效。需要进一步研究以对CA对全因死亡率的潜在影响进行有力分析。
