Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation - A randomized, controlled study
Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation - A randomized, controlled study
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DOI：
10.1161/01.cir.98.10.953
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发表时间：
1998-09-08
期刊：
影响因子：
37.8
通讯作者：
Lolli, G
中科院分区：
文献类型：
--
作者：
Brignole, M;Menozzi, C;Lolli, G
背景-非对照研究表明房室交界处消融和起搏器植入对慢性房颤患者的生活质量有良好的影响。方法和结果：我们对66例慢性房颤(持续6个月)患者进行了多中心、对照、随机、12个月的临床疗效评估。在研究完成之前，药物组有8名患者停药，Abl+PM组有4名患者停药。在12个月末，完成研究的28名ABL+PM患者的心悸(-78%；P=0.000)和努力呼吸困难(-22%；P=0.05)评分低于药物组的26名。得分较低的还有运动不耐受(-20%)、易疲劳(-17%)、胸部不适(-50%)、心力衰竭生活问卷(-14%)、纽约心脏协会功能分级(-4%)和活动评分(-12%)。登记和12个月的患者内比较显示，在Abl+PM组，除易疲劳外，所有变量均显著改善，从14%提高到82%。然而，由于药物组也有改善，两组之间的差异仅在心悸(P=0.000)、努力呼吸困难(P=0.01)、运动耐量(P=0.005)、易疲劳(P=0.02)和胸部不适(P=0.02)方面有显著差异。通过标准超声心动图和运动试验评估的心功能在两组之间没有显著差异，并且随着时间的推移保持稳定。结论-在心力衰竭和慢性房颤患者中，Abl+PM治疗在控制症状方面是有效的，并且优于DME治疗，尽管其疗效似乎不如未对照研究中观察到的，因为药物治疗的患者也可以期待一些改善。心脏功能不会因治疗而改变。
Background-Uncontrolled studies have suggested that atrioventricular junction ablation and pacemaker implantation have beneficial effects on quality of life in patients with chronic atrial fibrillation (AF).Methods and Results-We performed a multicenter, controlled, randomized, 12-month evaluation of the clinical effects of atrioventricular junction ablation and VVIR pacemaker (Abl+Pm) versus pharmacological (drug) treatment in 66 patients with chronic (lasting >6 months) AF who had clinically manifest heart failure and heart rate >90 bpm on 3 standard ECGs recorded at rest during stable clinical conditions on different days. Before completion of the study, withdrawals occurred in 8 patients of the drug group and in 4 patients of the Abl+Pm group. At the end of the 12 months, the 28 Abl+Pm patients who completed the study showed lower scores in palpitations (-78%; P=0.000) and effort dyspnea (-22%; P=0.05) than the 26 of the drug group. Lower scores, although not significant, were also observed for exercise intolerance (-20%), easy fatigue (-17%), chest discomfort (-50%), Living with Heart Failure Questionnaire (-14%), New York Heart Association functional classification (-4%), and Activity scale (-12%). The intrapatient comparison between enrollment and month 12 showed that in the Abl+Pm group, all variables except easy fatigue improved significantly from 14% to 82%. However, because an improvement was also observed in the drug group, the difference between the 2 groups was significant only for palpitations (P=0.000), effort dyspnea (P=0.01), exercise intolerance (P=0.005), easy fatigue (P=0.02), and chest discomfort (P=0.02). Cardiac performance, evaluated by means of standard echocardiogram and exercise test, did not differ significantly between the 2 groups and remained stable over time.Conclusions-In patients with heart failure and chronic AF, Abl+Pm treatment is effective and superior to dme therapy in controlling symptoms, although its efficacy appears to be less than that observed in uncontrolled studies because some improvement can also be expected in medically treated patients. Cardiac performance is not modified by the treatment.