Yeo Yong Hao, Vignarajah Aravinthan, Kin Wong Hermon Kha, Vigneswaramoorthy Nishanthi, Tan Jian Liang, Yeneneh Beeletsega T, Scott Luis, Srivathsan Komandoor, Lee Justin, Sorajja Dan
Department of Internal Medicine/Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
Department of Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA.
J Interv Card Electrophysiol. 2025 Aug 23. doi: 10.1007/s10840-025-02117-5.
Pulmonary vein isolation (PVI) has increasingly demonstrated superiority over antiarrhythmic drugs (AAD) for rhythm control in atrial fibrillation (AF). However, large-scale, long-term, real-world studies comparing these two therapies as first-line AF management remain limited.
Using the TriNetX network, we identified patients (≥ 18 years old) with AF between 2012 and 2019. Patients were categorized into two cohorts: PVI vs. AAD as first-line therapy for AF. Patients were followed for 5 years, with the primary outcome being a composite of all-cause death, all-cause hospitalization, and heart failure exacerbation. Secondary outcomes included ischemic stroke and major bleeding events (intracranial bleeding/ gastrointestinal bleeding). Subanalyses were performed in the paroxysmal and persistent AF cohorts, respectively.
Among 342,230 eligible patients, 2,638 patients (mean age 64.3 ± 10.6 years) who underwent PVI and 2,638 patients (mean age 64.2 ± 13.1 years) who had AAD as first-line therapy for AF had similar propensity scores and were included in the analysis. At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. Similar outcomes were seen in both the paroxysmal and persistent AF cohorts.
After a 5-year follow-up period, PVI was associated with better clinical outcomes than AAD as first-line therapy for AF.
在房颤（AF）的节律控制方面，肺静脉隔离（PVI）已越来越多地显示出优于抗心律失常药物（AAD）。然而，比较这两种疗法作为房颤一线治疗的大规模、长期、真实世界研究仍然有限。
利用TriNetX网络，我们确定了2012年至2019年间患有房颤的患者（≥18岁）。患者被分为两个队列：PVI组与AAD组作为房颤的一线治疗。对患者进行了5年的随访，主要结局是全因死亡、全因住院和心力衰竭加重的复合结局。次要结局包括缺血性卒中和重大出血事件（颅内出血/胃肠道出血）。分别对阵发性和持续性房颤队列进行了亚组分析。
在342,230名符合条件的患者中，2,638名接受PVI治疗的患者（平均年龄64.3±10.6岁）和2,638名接受AAD作为房颤一线治疗的患者（平均年龄64.2±13.1岁）具有相似的倾向评分，并被纳入分析。在5年随访时，与AAD组相比，PVI组的主要复合结局风险更低（42.0%对51.1%；HR 0.76；95%CI，0.71 - 0.83；P < 0.01）。他们的全因死亡率风险也更低（4.1%对7.7%；HR 0.53；95%CI，0.42 - 0.67；P < 0.01），全因住院率（35.1%对42.2%；HR 0.77；95%CI，0.71 - 0.84；P < 0.01），以及心力衰竭加重率（21.0%对24.3%；HR 0.85；95%CI，0.76 - 0.95；P < 0.01）。缺血性卒中（6.1%对6.7%；HR 0.90；95%CI，0.73 - 1.12；P = 0.34）和重大出血事件（4.3%对5.3%；HR 0.80；95%CI，0.62 - 1.02；P = 0.08）在两组之间相似。阵发性和持续性房颤队列中均观察到相似的结果。
经过5年的随访期，作为房颤的一线治疗，PVI与比AAD更好的临床结局相关。
