Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure
Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure
复制标题
心力衰竭心房颤动的消融与药物治疗
作者：
D. Packer;J. Piccini;K. Monahan;H. Al;A. Silverstein;P. Noseworthy;J. Poole;T. Bahnson;Kerry L Lee;D. Mark
补充数字内容可在文本中找到。背景：在心力衰竭和心房颤动（AF）患者中，一些临床试验报告了导管消融改善的结果，包括房颤复发的自由、生活质量和生存率。本文描述了CABANA试验（导管消融与心房颤动抗心律失常药物治疗）中AF合并心力衰竭患者的治疗相关结果。方法：CABANA试验随机选取2204例年龄≥65岁或<65岁且卒中危险因素≥1的房颤患者，在126个部位进行肺静脉隔离消融或包括速率或节律控制药物在内的药物治疗。其中，778人（35%）在基线时纽约心脏协会分级为>II，构成了本文的主题。CABANA试验的主要终点是死亡、致残性中风、严重出血或心脏骤停的复合终点。结果：CABANA纳入的778例心力衰竭患者中，378例接受消融术治疗，400例接受药物治疗。571例患者（73.0%）可获得基线射血分数，其中9.3%的患者射血分数<40%，而11.7%的患者射血分数在40%至50%之间。在意向治疗分析中，在48.5个月的中位随访期间，与单纯药物治疗相比，消融组的主要复合终点相对降低36%（风险比0.64 [95% CI, 0.41-0.99]），全因死亡率相对降低43%（风险比0.57 [95% CI, 0.33-0.96]）。消融后房颤复发率降低（风险比0.56 [95% CI, 0.42-0.74]）。在整个60个月的随访中，AFEQT（房颤对生活质量的影响）总评分的调整平均差值为5.0分，有利于消融组（95% CI, 2.5-7.4分），而MAFSI（梅奥房颤特异性症状量表）频率评分差值为-2.0分，有利于消融组（95% CI, -2.9至-1.2）。结论：在CABANA试验中，在试验开始时临床诊断为稳定型心衰的房颤患者中，相对于药物治疗，导管消融在生存、房颤复发和生活质量方面产生了临床上重要的改善。这些结果是在大多数左心室功能保留的队列中获得的，需要独立的试验验证。注册：网址：https://www.clinicaltrials.gov/ct2/show/NCT00911508；唯一标识符：NCT0091150。
Supplemental Digital Content is available in the text. Background: In patients with heart failure and atrial fibrillation (AF), several clinical trials have reported improved outcomes, including freedom from AF recurrence, quality of life, and survival, with catheter ablation. This article describes the treatment-related outcomes of the AF patients with heart failure enrolled in the CABANA trial (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation). Methods: The CABANA trial randomized 2204 patients with AF who were ≥65 years old or <65 years old with ≥1 risk factor for stroke at 126 sites to ablation with pulmonary vein isolation or drug therapy including rate or rhythm control drugs. Of these, 778 (35%) had New York Heart Association class >II at baseline and form the subject of this article. The CABANA trial’s primary end point was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Results: Of the 778 patients with heart failure enrolled in CABANA, 378 were assigned to ablation and 400 to drug therapy. Ejection fraction at baseline was available for 571 patients (73.0%), and 9.3% of these had an ejection fraction <40%, whereas 11.7% had ejection fractions between 40% and 50%. In the intention-to-treat analysis, the ablation arm had a 36% relative reduction in the primary composite end point (hazard ratio, 0.64 [95% CI, 0.41–0.99]) and a 43% relative reduction in all-cause mortality (hazard ratio, 0.57 [95% CI, 0.33–0.96]) compared with drug therapy alone over a median follow-up of 48.5 months. AF recurrence was decreased with ablation (hazard ratio, 0.56 [95% CI, 0.42–0.74]). The adjusted mean difference for the AFEQT (Atrial Fibrillation Effect on Quality of Life) summary score averaged over the entire 60-month follow-up was 5.0 points, favoring the ablation arm (95% CI, 2.5–7.4 points), and the MAFSI (Mayo Atrial Fibrillation-Specific Symptom Inventory) frequency score difference was –2.0 points, favoring ablation (95% CI, –2.9 to –1.2). Conclusions: In patients with AF enrolled in the CABANA trial who had clinically diagnosed stable heart failure at trial entry, catheter ablation produced clinically important improvements in survival, freedom from AF recurrence, and quality of life relative to drug therapy. These results, obtained in a cohort most of whom had preserved left ventricular function, require independent trial verification. Registration: URL: https://www.clinicaltrials.gov/ct2/show/NCT00911508; Unique identifier: NCT0091150.
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DOI：
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发表时间：
1972
期刊：
--
影响因子：
--
作者：
D. Cox
通讯作者：
D. Cox
影响因子：
24
作者：
Miyasaka, Yoko;Barnes, Marion E.;Tsang, Teresa S. M.
通讯作者：
Tsang, Teresa S. M.
影响因子：
120.7
作者：
Conen, David;Chae, Claudia U.;Glynn, Robert J.;Tedrow, Usha B.;Everett, Brendan M.;Buring, Julie E.;Albert, Christine M.
通讯作者：
Albert, Christine M.
影响因子：
20.1
作者：
Pfeffer, Marc A.;Shah, Amil M.;Borlaug, Barry A.
通讯作者：
Borlaug, Barry A.
影响因子：
5.5
作者：
Calkins, Hugh;Hindricks, Gerhard;Yamane, Teiichi
通讯作者：
Yamane, Teiichi