Impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry
Impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry
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DOI：
10.1007/s00380-021-01929-5
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发表时间：
2021-09-15
影响因子：
1.5
通讯作者：
Okumura, Yasuo
中科院分区：
文献类型：
--
作者：
Usuda, Keisuke;Kato, Takeshi;Okumura, Yasuo
心房颤动（AF）的导管消融对心血管事件和死亡率的影响是有争议的。我们研究了窦性心律维持对房颤消融后主要不良心脑血管事件的影响，研究对象为日本多中心房颤消融队列。我们调查了3326例房颤患者（25.8%为女性，平均年龄63.3±10.3岁），随访房颤前沿消融登记的长期预后和房颤消融后抗凝剂的使用情况。主要终点是卒中、短暂性脑缺血发作、心血管事件和全因死亡的综合结果。在平均24.0个月的随访期间，2339例（70.3%）患者在导管消融后无房颤，144例（4.3%）患者出现主要复合终点。与AF复发组（3.0 / 100人年，p = 0.003）相比，AF未复发组的主要终点发生率（1.8 / 100人年）显著降低。多因素分析显示，无房颤（风险比0.61,95%可信区间0.44-0.86,p = 0.005）与复合事件的发生率独立相关。在房颤消融的多中心队列中，导管消融后窦性心律维持与较低的主要心脑血管不良事件发生率独立相关。
The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. We investigated 3326 consecutive patients (25.8% female, mean age 63.3 +/- 10.3 years) who underwent catheter ablation for AF from the atrial fibrillation registry to follow the long-term outcomes and use of anti coagulants after ablation (AF frontier ablation registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 24.0 months, 2339 (70.3%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 144 (4.3%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.8 per 100 person-years) compared with the AF recurrence group (3.0 per 100 person-years, p = 0.003). The multivariate analysis revealed that freedom from AF (hazard ratio 0.61, 95% confidence interval 0.44-0.86, p = 0.005) was independently associated with the incidence of the composite event. In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.