Catheter ablation improves outcomes and quality of life in Japanese patients with early-stage atrial fibrillation: A retrospective cohort study
Catheter ablation improves outcomes and quality of life in Japanese patients with early-stage atrial fibrillation: A retrospective cohort study
复制标题
导管消融可改善日本早期房颤患者的预后和生活质量：一项回顾性队列研究
DOI：
10.1016/j.hrthm.2022.02.017
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发表时间：
2022
期刊：
影响因子：
5.5
通讯作者：
Takatsuki Seiji
中科院分区：
文献类型：
--
作者：
Seki Yuta;Fujisawa Taishi;Ikemura Nobuhiro;Ibe Susumu;Tsuzuki Ippei;Hashimoto Kenji;Yamashita Terumasa;Miyama Hiroshi;Niimi Nozomi;Suzuki Masahiro;Negishi Koji;Katsumata Yoshinori;Kimura Takehiro;Fukuda Keiichi;Kohsaka Shun;Takatsuki Seiji
背景导管消融术被广泛用作生活质量受损患者的一线治疗;但是，在此情况下，导管消融术是否能改善房颤（AF）患者的生存率和其他结局尚不清楚。本研究的目的是使用来自当代日本多中心登记的早期房颤患者的数据，评价导管消融术是否能减少不良临床结局并改善患者的生活质量。在2014年至2018年期间，Keio医院间心血管疾病-房颤登记了3318名在参与医院新诊断或转诊的AF患者。根据47个人口统计学变量进行倾向评分匹配。我们抽取了823对接受导管消融或单独药物治疗的患者。主要结局是2年随访期间全因死亡、中风、出血事件和心力衰竭住院的复合结局。此外，房颤对生活质量评分的影响在基线和1年follow-up.ResultsWithin匹配的队列，自房颤诊断的中位时间为0.3年（四分位距[IQR] 0.1 <$2.3年），年龄为67.0岁（IQR 59.0 <$73.0岁），和CHA 2DS 2-VASc评分为2.0（IQR 1.0 <$2.0）。在730天的中位随访期内（IQR 366 ± 731天），接受导管消融术的患者的主要结局风险较低（风险比0.49; 95%置信区间0.30 - 0.79;P= 0.004），心力衰竭住院的风险显著降低（危害比0.33; 95%置信区间0.14-0.77; P= 0.010）和改善房颤对生活质量评分的影响，而不是那些接受药物治疗的患者。与药物治疗相比，导管消融术与不良临床事件的风险较低和生活质量改善相关。
BackgroundCatheter ablation is widely used as first-line therapy for patients with impaired quality of life; however, whether catheter ablation improves survival and other outcomes in atrial fibrillation (AF) cases remains unclear.ObjectiveThe purpose of this study was to evaluate whether catheter ablation reduces adverse clinical outcomes and improves patients’ quality of life using data from a contemporary Japanese multicenter registry of patients with early-stage AF.MethodsThe Keio Interhospital Cardiovascular Studies-Atrial Fibrillation registered 3318 patients with AF newly diagnosed at or referred to participating hospitals between 2014 and 2018. Propensity score matching based on 47 demographic variables was performed. We extracted 823 pairs who underwent catheter ablation or medical therapy alone. The primary outcome was the composite of all-cause death, stroke, bleeding events, and heart failure hospitalization during a 2-year follow-up period. Additionally, the Atrial Fibrillation Effect on QualiΤy-of-Life scores at baseline and 1-year follow-up were evaluated.ResultsWithin the matched cohort, the median time since AF diagnosis was 0.3 years (interquartile range [IQR] 0.1‒2.3 years), age was 67.0 years (IQR 59.0‒73.0 years), and the CHA2DS2-VASc score was 2.0 (IQR 1.0‒2.0). During a median follow-up period of 730 days (IQR 366‒731 days), patients who underwent catheter ablation had a lower risk of primary outcomes (hazard ratio 0.49; 95% confidence interval 0.30‒0.79;P= .004), with a significantly lower risk of heart failure hospitalization (hazard ratio 0.33; 95% confidence interval 0.14–0.77;P= .010) and improved Atrial Fibrillation Effect on QualiΤy-of-Life scores, than did those who received medical therapy.ConclusionIn patients with propensity score–matched, early-stage, real-world AF, catheter ablation was associated with a lower risk of adverse clinical events and improved quality of life as compared with medical therapy.