Long-term outcome of catheter ablation for atrial fibrillation in patients with severe left atrial enlargement and reduced left ventricular ejection fraction
Long-term outcome of catheter ablation for atrial fibrillation in patients with severe left atrial enlargement and reduced left ventricular ejection fraction
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DOI：
10.1093/europace/euab213
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发表时间：
2021-09-17
期刊：
影响因子：
6.1
通讯作者：
Auricchio, Angelo
中科院分区：
文献类型：
--
作者：
Demarchi, Andrea;Neumann, Laura;Auricchio, Angelo
目的关于导管消融治疗严重左心房扩张性心衰患者左室射血分数（LVEF）降低的疗效资料很少。我们试图评估导管消融在LVEF降低和严重左心房（LA）扩大患者中的疗效，并将其与左心室功能保留和左心房同等扩张的患者进行比较。方法和结果采用第一肺静脉隔离术（PVI）治疗阵发性或持续性心房颤动（AF）患者分为三组：第一组包括LA容量正常或轻度异常（48mL/m(2)）、LVEF正常的患者；组3包括严重LA增大和LVEF降低的患者。时间到事件分析用于调查房颤复发。该研究队列包括439例患者；第3组有较高的心血管危险因素。LA扩大与房颤复发风险增加两倍相关，相反，随着LVEF进一步减少，仅显示出较小的无显著性增加30%。结论严重LA扩张和LVEF减少的患者的长期预后与严重LA扩大但LVEF保留的患者相当。PVI的长期疗效肯定会受到左心房扩大的影响，但受LVEF减少的影响较小。在该亚组患者中，CA仍然是控制阵发性和持续性房颤的最佳策略。
Aims Data regarding the efficacy of catheter ablation in heart failure patients with severely dilated left atrium and reduced left ventricular ejection fraction (LVEF) are scanty. We sought to assess the efficacy of catheter ablation in patients with reduced LVEF and severe left atrial (LA) enlargement, and to compare it to those patients with preserved left ventricular function and equally dilated left atrium.Methods and results Three patient groups with paroxysmal or persistent atrial fibrillation (AF) undergoing a first pulmonary vein isolation (PVI) were considered: Group 1 included patients with normal or mildly abnormal LA volume (48mL/m(2)) and normal LVEF; and Group 3 included patients with severe LA enlargement and reduced LVEF. Time to event analysis was used to investigate AF recurrences. The study cohort includes 439 patients; Group 3 had a higher prevalence of cardiovascular risk factors. LA enlargement was associated with a two-fold in risk of AF recurrence, on the contrary only a smaller non-significant increase of 30% was shown with the further addition of LVEF reduction.Conclusions The long-term outcome of patients with severe LA dilatation and reduced LVEF is comparable to those with severe LA enlargement but preserved LVEF. Long-term efficacy of PVI is certainly affected by the enlargement of the left atrium, but less so by the addition of a reduced LVEF. CA remains the best strategy for rhythm control both in paroxysmal and persistent AF in this subgroup of patients.