Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure
Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure
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DOI：
10.1016/j.jjcc.2018.02.012
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发表时间：
2018-09-01
影响因子：
2.5
通讯作者：
Iesaka, Yoshito
中科院分区：
文献类型：
--
作者：
Ichijo, Sadamitsu;Miyazaki, Shinsuke;Iesaka, Yoshito
背景：心力衰竭（HF）促进心房颤动（AF），AF加重HF。本研究的目的是探讨长期的临床结果后，AF消融术在HF.Methods和结果：共106个连续的HF患者，包括51（48.1%）与左心室射血分数（LVEF）（HFrEF）和55（51.9%）与保存LVEF（HFpEF），进行了AF消融术。所有患者均成功行肺静脉窦隔离术，其中38例（35.8%）加用基质改良。平均随访期为32.4 ± 18.6个月，平均手术次数为每例患者1.4 ± 0.5次。29例（27.3%）患者合并使用低剂量抗肿瘤药物。HFrEF患者3年时无复发性房性心律失常（ATa）、HF相关住院和复合终点（全因死亡、卒中、HF相关住院）分别为88.7%、97.6%和97.6%，HFpEF患者分别为79.3%、96.2%和91.8%。在37例（72.5%）HFrEF患者中观察到消融术后LVEF正常化（>50%），较小的LV舒张期直径（LVDd）是唯一预测因素[比值比（OR）= 0.863; 95%置信区间（CI）= 0.779-0.955，p = 0.0051]。在16例患者中观察到LVDd缩短（>= 5 mm）（29.1%）消融后HFpEF患者，初次手术后无复发是唯一预测因素（OR = 6.229; 95%CI = 1.524-25.469，p = 0.011）。房颤的导管消融术可能是管理HF合并房颤患者的重要治疗选择之一，无论HF类型如何。(C)2018年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Heart failure (HF) promotes atrial fibrillation (AF) and AF worsens HF. This study aimed to investigate the long-term clinical outcomes after AF ablation in patients with HF.Methods and results: A total of 106 consecutive HF patients, including 51 (48.1%) with a reduced left ventricular ejection fraction (LVEF) (HFrEF) and 55 (51.9%) with a preserved LVEF (HFpEF), underwent AF ablation. All patients underwent successful pulmonary vein antrum isolation, and substrate modification was added in 38 (35.8%). The mean follow-up period was 32.4 +/- 18.6 months, and mean number of procedures was 1.4 +/- 0.5 per patient. Low-dose antiarrhythmic drugs were combined in 29 (27.3%) patients. Freedom from recurrent atrial arrhythmias (ATa), HF-related hospitalizations, and the composite endpoint (all-cause death, stroke, HF-related hospitalizations) at 3 years was 88.7%, 97.6%, and 97.6% in HFrEF patients, and 79.3%, 96.2%, and 91.8% in HFpEF patients, respectively. LVEF normalization (>50%) was observed in 37 (72.5%) HFrEF patients post-ablation, and a smaller LV diastolic diameter (LVDd) was the sole predictor [odds ratio (OR) = 0.863; 95% confidence interval (CI) = 0.779-0.955, p = 0.0051. Shortening of the LVDd (>= 5 mm) was observed in 16 (29.1%) HFpEF patients post-ablation, and no recurrence after the initial procedure was the sole predictor (OR = 6.229; 95% CI = 1.524-25.469, p = 0.011).Conclusions: Catheter ablation of AF could be one of the important therapeutic options in the management of patients with HF combined with AF regardless of the type of HF. (C) 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.