Che Qian-Ji, Qiu Jun-Hao, Sun Jian, Chen Mu, Li Wei, Wang Qun-Shan, Zhang Peng-Pai, Yang Yu-Li, Zhang Rui, Li Yi-Gang
Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China.
Int J Cardiol Heart Vasc. 2024 Dec 28;56:101589. doi: 10.1016/j.ijcha.2024.101589. eCollection 2025 Feb.
Acute decompensated heart failure (ADHF) is often accompanied by persistent atrial fibrillation (AF). However, the optimal timing for RFCA in patients with persistent AF and ADHF is still uncertain.
The aim of this observational cohort study is to investigate the safety and efficacy of early RFCA in patients with persistent AF after ADHF attack.
Patients with persistent AF and ADHF who underwent early RFCA as soon as the ADHF symptoms were initially controlled (Early group, n = 63) and those who received elective procedures after a transitional period (Elective group, n = 67) were investigated. After 1:1 propensity score matching, 50 matched pairs were analyzed.
The overall procedural complication rates were similar (Early group: 6.0 %, n = 3; Elective group: 6.0 %, n = 3; P = 1.000). Patients in the early group had significantly less HF rehospitalization than the elective group during the 1-year post-procedure follow-up period (Mantel-Cox test: P = 0.036; HR: 0.369; 95 %CI: 0.145-0.938), though AF recurrence showed no difference (Mantel-Cox test: P = 0.645; HR: 1.204; 95 %CI: 0.547-2.648). A 90-day rehospitalization rate was significantly higher in the transitional period in the elective group, compared with patients who already received early RFCA (Elective group: 13, 26.0 %; Early group: 2, 4.0 %; P = 0.002).
Early RFCA therapy for persistent AF after ADHF attack was safe and effective. Patients who received early RFCA therapy had significantly less HF rehospitalization in the 1-year post-procedure follow-up period. On the other hand, the elective procedure was accompanied by a higher risk of HF rehospitalization during the waiting period.
急性失代偿性心力衰竭（ADHF）常伴有持续性心房颤动（AF）。然而，持续性AF合并ADHF患者行射频导管消融术（RFCA）的最佳时机仍不确定。
本观察性队列研究旨在探讨ADHF发作后早期RFCA治疗持续性AF患者的安全性和有效性。
对ADHF症状初步得到控制后尽早接受早期RFCA治疗的持续性AF合并ADHF患者（早期组，n = 63）和经过一段过渡期后接受择期手术的患者（择期组，n = 67）进行研究。经1:1倾向评分匹配后，对50对匹配病例进行分析。
总体手术并发症发生率相似（早期组：6.0%，n = 3；择期组：6.0%，n = 3；P = 1.000）。在术后1年随访期内，早期组患者因心力衰竭再次住院的次数显著少于择期组（Mantel-Cox检验：P = 0.036；风险比：0.369；95%置信区间：0.145 - 0.938），尽管房颤复发情况无差异（Mantel-Cox检验：P = 0.645；风险比：1.204；95%置信区间：0.547 - 2.648）。与已接受早期RFCA治疗的患者相比，择期组在过渡期的90天再住院率显著更高（择期组：13例，26.0%；早期组：2例，4.0%；P = 0.002）。
ADHF发作后早期RFCA治疗持续性AF安全有效。接受早期RFCA治疗的患者在术后1年随访期内因心力衰竭再次住院的次数显著更少。另一方面，择期手术在等待期伴有更高的因心力衰竭再次住院的风险。
