Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a European observational multicentre study
Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a European observational multicentre study
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肥厚型心肌病患者心房颤动的导管消融：一项欧洲观察性多中心研究
DOI：
10.1093/europace/euab022
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发表时间：
2021-04-30
期刊：
影响因子：
6.1
通讯作者：
Providencia, Rui
中科院分区：
文献类型：
--
作者：
Creta, Antonio;Elliott, Perry;Providencia, Rui
目的房颤（AF）是肥厚性心肌病（HCM）的常见病。导管消融治疗房颤在HCM患者中的疗效数据很少。方法和结果观察性多中心研究137例HCM患者（平均年龄55.0±13.4岁，29.1%为女性；225例消融手术）。我们研究了(1)导管消融治疗房颤超过12个月的疗效；（ii）现有的风险评分、分层方案和基因型作为心律失常复发的潜在预测因素，以及（iii）冷冻球囊与射频对手术结果的影响。平均随访时间为43.8±37.0个月。消融后最初的12个月复发是常见的，在指数手术后的24个月，几乎所有的持续性房颤患者都复发了，只有40%的阵发性房颤患者没有心律失常复发。APPLE评分对房颤消融后复发有一定的判别能力（c统计值0.63,95% CI 0.52-0.75; P = 0.022），而猝死的风险分层方案则没有。在多变量分析中，左心房直径和左室顶动脉瘤是复发的独立预测因素。58例患者进行基因分型；不同基因突变的受试者无心律失常生存率相似。手术并发症的发生率很高（9.3%），尽管随着时间的推移有所降低。低温球囊消融和射频消融的结果是相似的。结论HCM患者消融后非常晚的房颤复发是常见的，尤其是持续性房颤患者。左心房大小、左室顶动脉瘤和APPLE评分可能有助于识别心律失常复发风险较高的受试者。首次冷冻球囊术与射频消融术相当。
Aims Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). Data on the efficacy of catheter ablation of AF in HCM patients are sparse.Methods and results Observational multicentre study in 137 HCM patients (mean age 55.0 +/- 13.4, 29.1% female; 225 ablation procedures). We investigated (i) the efficacy of catheter ablation for AF beyond the initial 12 months; (ii) the available risk scores, stratification schemes and genotype as potential predictors of arrhythmia relapse, and (iii) the impact of cryoballoon vs. radiofrequency in procedural outcomes. Mean follow-up was 43.8 +/- 37.0 months. Recurrences after the initial 12-month period post-ablation were frequent, and 24 months after the index procedure, nearly all patients with persistent AF had relapsed, and only 40% of those with paroxysmal AF remained free from arrhythmia recurrence. The APPLE score demonstrated a modest discriminative capacity for AF relapse post-ablation (c-statistic 0.63, 95% CI 0.52-0.75; P = 0.022), while the risk stratification schemes for sudden death did not. On multivariable analysis, left atrium diameter and LV apical aneurysm were independent predictors of recurrence. Fifty-eight patients were genotyped; arrhythmia-free survival was similar among subjects with different gene mutations. Rate of procedural complications was high (9.3%), although reducing over time. Outcome for cryoballoon and radiofrequency ablation was comparable.Conclusion Very late AF relapses post-ablation is common in HCM patients, especially in those with persistent AF. Left atrium size, LV apical aneurysm, and the APPLE score might contribute to identify subjects at higher risk of arrhythmia recurrence. First-time cryoballoon is comparable with radiofrequency ablation.