心房颤动患者起搏与消融策略的长期预后

Long-term outcomes of pace-and-ablate strategy in patients with atrial fibrillation.

作者信息

van Koll Johan, Engels Madelon D E A, Rijks Jesse H J, Salari Madelon, Luijten Jelle, Lumens Joost, van Empel Vanessa P M, Westra Sjoerd W, van Stipdonk Antonius M W, Lankveld Theo A R, Chaldoupi Sevasti M, Joza Jacqueline, Beukema Rypko J, Luermans Justin G L M, Linz Dominik K, Vernooy Kevin

机构信息

Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.

Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.

出版信息

J Interv Card Electrophysiol. 2025 Apr 7. doi: 10.1007/s10840-025-02038-3.

DOI:10.1007/s10840-025-02038-3

PMID:40195231

Abstract

BACKGROUND

The pace-and-ablate strategy is second -line therapy to obtain rate control in patients with persistent symptomatic atrial fibrillation (AF) when other treatment options fail. This study aims to evaluate long-term effects on clinical outcomes following pace-and-ablate strategy in AF patients.

METHODS

This retrospective study includes patients who underwent successful pacemaker implantation (right ventricular pacing (RVP) or cardiac re-synchronization therapy (CRT)) followed by atrioventricular node ablation (AVNA) between 2010 and 2020. Patients were treated according to the prevailing guidelines. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization (HFH). Secondary endpoints were individual outcomes of all-cause mortality, HFH, and left-ventricular ejection fraction (LVEF) change.

RESULTS

Two hundred ninety-eight patients were included, 162 undergoing RVP, and 136 receiving CRT, with a median follow-up of 5.8 years [4.1-8.0]. The primary endpoint occured in 47% of the RVP group and 49% of the CRT group (p = 0.206). All-cause mortality occurred in 36% of the RVP group and in 45% of the CRT group (p = 0.005). HFH occurred in 22% of the RVP group and in 15% of the CRT group (p = 0.328), with 17(10%) upgrades to CRT in the RVP group. Median LVEF in the RVP group remained stable (56% [49-60] to 53% [43-57]; p = 0.081), while it improved in the CRT group (31% [22-38] to 43% [32-51]; p < 0.001).

CONCLUSION

Mortality and HFH in patients with AF managed through a pace-and-ablate strategy are high. Reassuringly, LVEF deterioration requiring upgrade to CRT is uncommon in patients undergoing RVP with normal baseline LVEF before AVNA. CRT improves LVEF in patients with reduced LVEF before AVNA.

摘要

背景

当其他治疗选择无效时，起搏消融策略是用于控制持续性症状性心房颤动（AF）患者心率的二线治疗方法。本研究旨在评估起搏消融策略对AF患者临床结局的长期影响。

方法

这项回顾性研究纳入了2010年至2020年间成功植入起搏器（右心室起搏（RVP）或心脏再同步治疗（CRT））并随后进行房室结消融（AVNA）的患者。患者按照现行指南进行治疗。主要终点是全因死亡率和心力衰竭住院（HFH）的复合终点。次要终点是全因死亡率、HFH和左心室射血分数（LVEF）变化的个体结局。

结果

共纳入298例患者，其中162例行RVP，136例接受CRT，中位随访时间为5.8年[4.1 - 8.0]。主要终点在RVP组的发生率为47%，在CRT组为49%（p = 0.206）。全因死亡率在RVP组为36%，在CRT组为45%（p = 0.005）。HFH在RVP组的发生率为22%，在CRT组为15%（p = 0.328），RVP组中有17例（10%）升级为CRT。RVP组的LVEF中位数保持稳定（从56%[49 - 60]降至53%[43 - 57]；p = 0.081），而CRT组则有所改善（从31%[22 - 38]升至43%[32 - 51]；p < 0.001）。