Catheter ablation for atrial fibrillation in HFpEF patients-A propensity-score-matched analysis
Catheter ablation for atrial fibrillation in HFpEF patients-A propensity-score-matched analysis
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DOI：
10.1111/jce.15200
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发表时间：
2021-08-18
影响因子：
2.7
通讯作者：
Dahme, Tillman
中科院分区：
文献类型：
--
作者：
Rattka, Manuel;Kuehberger, Anna;Dahme, Tillman
背景 射血分数保留的心力衰竭 (HFpEF) 和心房颤动 (AF) 都是与高发病率和死亡率相关的常见疾病，特别是当它们共存时。最近显示，AF 导管消融 (CA) 可以诱导 HFpEF 患者的逆转重塑并改善症状。本研究的目的是比较患有 HFpEF 的 AF 患者的结局，这些患者要么因 AF 接受 CA 治疗，要么仅接受药物治疗。方法和结果 我们纳入了 2013 年至 2018 年间根据现行指南在我院接受治疗的所有患有 HFpEF 的 AF 患者。在 6614 名 AF 患者中，我们确定了 127 名确诊为 HFpEF 的患者。应用倾向评分匹配平衡患者组后，对 43 名接受 CA 治疗的患者和 43 名接受药物治疗的患者进行了比较。 CA 组患者平均接受 1.5 +/- 0.8 次消融手术。 CA 组心律失常复发的发生率显着降低（风险比 [HR]：0.47；95% CI：0.25-0.87；p = 0.016）。与药物治疗相比，CA 显着降低了主要终点（包括心力衰竭住院和死亡）（HR：0.30；95% CI：0.13-0.67；p = 0.003）。这是由于心力衰竭住院人数减少所致。仅在 CA 后，HFpEF 的临床和超声心动图参数才显着改善。值得注意的是，随访结束时对 HFpEF 诊断标准的重新评估表明，接受 CA 治疗的 43 名患者中，有 15 名 (35%) 的 HFpEF 得到缓解，而 43 名接受药物治疗的患者中，只有 4 名 (9%) 得到缓解 (p = .008)。结论 与药物治疗相比，HFpEF 患者房颤导管消融术可减少心力衰竭住院次数、心力衰竭症状，并改善舒张功能。对于 HFpEF 合并 AF 的患者应考虑 AF 消融。
Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are both common conditions associated with high morbidity and mortality, especially if they coexist. Catheter ablation (CA) for AF has been shown recently to induce reverse remodeling and improve symptoms in HFpEF patients. The aim of this study was to compare outcomes of AF patients with HFpEF, who either underwent CA for AF or received medical therapy only. Methods and Results We included all AF patients with HFpEF according to current guidelines treated at our hospital between 2013 and 2018. Out of 6614 AF patients, we identified 127 with confirmed HFpEF. After applying propensity score matching to balance patient groups, 43 patients treated by CA and 43 patients receiving medical treatment were compared. Patients in the CA group underwent a mean of 1.5 +/- 0.8 ablation procedures. Arrhythmia recurrence occurred significantly less frequently in the CA group (hazard ratio [HR]: 0.47; 95% CI: 0.25-0.87; p = .016). The primary endpoint, a composite of heart failure hospitalization and death, was reduced significantly by CA compared to medical therapy (HR: 0.30; 95% CI: 0.13-0.67; p = .003). This was driven by a decrease in heart failure hospitalization. Clinical and echocardiographic parameters of HFpEF improved significantly only after CA. Remarkably, reassessment of diagnostic HFpEF criteria at the end of follow-up demonstrated HFpEF resolution in 15 out of 43 patients (35%) treated by CA and only 4 out of 43 patients (9%) treated medically (p = .008). Conclusion Catheter ablation for AF in HFpEF patients in comparison to medical therapy decreases heart failure hospitalization, heart failure symptoms, and improves diastolic function. AF ablation should be considered in patients with HFpEF and concomitant AF.