Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation
Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation
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DOI：
10.1016/j.jacc.2014.09.028
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发表时间：
2014-12-02
影响因子：
24
通讯作者：
Sanders, Prashanthan
中科院分区：
文献类型：
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作者：
Pathak, Rajeev K.;Middeldorp, Melissa E.;Sanders, Prashanthan
背景心房颤动(房颤)消融的长期结果是磨耗。本研究的目的是评估危险因素和体重管理对房颤消融结果的影响。方法根据美国心脏协会/美国心脏病学会指南，对连续接受房颤消融的281例患者，其中149例体重指数=27 kg/m(2)和1个心脏危险因素进行了危险因素管理(RFM)。房颤消融后，选择射频消融的61例患者和88例对照组每隔3~6个月进行一次临床复查和7天动态心电图监测。结果两组患者在基线特征、手术次数和随访时间方面均无差异(P NS)。RFM使体重(p<0.002)和血压(p<0.006)显著降低，血糖控制(p<0.001)和血脂谱(p<0.01)得到改善。在随访中，与对照组相比，射频消融组的房颤频率、持续时间、症状和症状严重程度降低得更多(均P<；0.001)。与对照组相比，射频消融患者的单程序无心律失常存活率更高(p<；0.001)。使用抗心律失常药物的RFM患者的多程序无心律失常存活率显著高于对照组(p<；0.001)，分别为16%和42.4%(p 0.004)。多因素分析显示，房颤类型(P<；0.001)和射频消融(危险比4.8[95%可信区间：2.0 4~11.4]；P<；0.001)是无心律失常生存的独立预测因素。这项研究强调了针对房颤底物的主要启动子进行治疗以促进节律控制策略的重要性。(C)2014年，由美国心脏病学会基金会提供。
BACKGROUND The long-term outcome of atrial fibrillation (AF) ablation demonstrates attrition. This outcome may be due to failure to attenuate the progressive substrate promoted by cardiovascular risk factors.OBJECTIVES The goal of this study was to evaluate the impact of risk factor and weight management on AF ablation outcomes.METHODS Of 281 consecutive patients undergoing AF ablation, 149 with a body mass index >= 27 kg/m(2) and >= 1 cardiac risk factor were offered risk factor management (RFM) according to American Heart Association/American College of Cardiology guidelines. After AF ablation, all 61 patients who opted for RFM and 88 control subjects were assessed every 3 to 6 months by clinic review and 7-day Holter monitoring. Changes in the Atrial Fibrillation Severity Scale scores were determined.RESULTS There were no differences in baseline characteristics, number of procedures, or follow-up duration between the groups (p NS). RFM resulted in greater reductions in weight (p 0.002) and blood pressure (p 0.006), and better glycemic control (p 0.001) and lipid profiles (p 0.01). At follow-up, AF frequency, duration, symptoms, and symptom severity decreased more in the RFM group compared with the control group (all p < 0.001). Single-procedure drug-unassisted arrhythmia-free survival was greater in RFM patients compared with control subjects (p < 0.001). Multiple-procedure arrhythmia-free survival was markedly better in RFM patients compared with control subjects (p < 0.001), with 16% and 42.4%, respectively, using antiarrhythmic drugs (p 0.004). On multivariate analysis, type of AF (p < 0.001) and RFM (hazard ratio 4.8 [ 95% confidence interval: 2.04 to 11.4]; p < 0.001) were independent predictors of arrhythmia-free survival.CONCLUSIONS Aggressive RFM improved the long-term success of AF ablation. This study underscores the importance of therapy directed at the primary promoters of the AF substrate to facilitate rhythm control strategies. (C) 2014 by the American College of Cardiology Foundation.