心力衰竭患者房颤的导管消融治疗 - NEJM医学前沿
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心力衰竭患者房颤的导管消融治疗
Catheter Ablation for Atrial Fibrillation with Heart Failure


Nassir F. Marrouche ... 心脑血管疾病 • 2018.02.01
相关阅读
• 房颤消融术改善心力衰竭 • 心房颤动治疗方法的操作和质量指标更新 • 心房颤动指南还有很长的路要走

摘要


背景

房颤伴心力衰竭患者的死亡率和发病率高于单纯心力衰竭患者。有人建议对于正在接受适当治疗的心力衰竭患者,将房颤的导管消融作为一种改善结局的手段。

 

方法

我们在有症状的阵发性或持续性房颤患者中,将对抗心律失常药物没有反应,或有不可接受的副作用,或不愿意服用这些药物的患者,在进行基于指南的心力衰竭治疗同时,随机分配到导管消融(179例)或药物治疗(心率或节律控制)(184例)组。所有患者均达到纽约心脏学会(New York Heart Association)Ⅱ、Ⅲ或Ⅳ级心力衰竭,左心室射血分数为35%或更低,并已植入除颤器。主要终点是包含任何原因死亡或心力衰竭恶化住院的复合终点。

 

结果

在中位37.8个月的随访后,消融组发生主要复合终点事件的患者人数显著少于药物治疗组(51例患者[28.5%] vs. 82例患者[44.6%];风险比,0.62;95%置信区间[CI],0.43~0.87;P=0.007)。消融组中任何原因死亡(24例患者[13.4%] vs. 46例患者[25.0%];风险比0.53;95% CI,0.32~0.86;P=0.01)、心力衰竭恶化住院(37例患者[20.7%] vs. 66例患者[35.9%];风险比0.56;95% CI,0.37~0.83;P=0.004)以及心血管事件死亡(20例[11.2%] vs. 41例[22.3%];风险比0.49;95% CI,0.29~0.84;P=0.009)均显著减少。

 

结论

在房颤伴心力衰竭患者中,导管消融组的全因死亡或心力衰竭恶化住院等复合终点发生率显著低于药物治疗组(由Biotronik资助;CASTLE-AF在ClinicalTrials.gov注册号为NCT00643188)。





作者信息

Nassir F. Marrouche, M.D., Johannes Brachmann, M.D., Dietrich Andresen, M.D., Jürgen Siebels, M.D., Lucas Boersma, M.D., Luc Jordaens, M.D., Béla Merkely, M.D., Evgeny Pokushalov, M.D., Prashanthan Sanders, M.D., Jochen Proff, B.S., Heribert Schunkert, M.D., Hildegard Christ, M.D., Jürgen Vogt, M.D., and Dietmar Bänsch, M.D. for the CASTLE-AF Investigators*
From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.V.), Klinikum Links der Weser, Bremen (J.S.), Deutsches Herzzentrum München, Munich (H.S.), Institute of Medical Statistics and Computational Biology, Cologne (H.C.), and KMG Klinikum, Güstrow (D.B.) — all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.B.), and the Erasmus University Medical Center, Rotterdam (L.J.) — both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (B.M.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (E.P.). Address reprint requests to Dr. Marrouche at the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT 84132, or at nassir.marrouche@carma.utah.edu. *A complete list of the investigators in the CASTLE-AF trial is provided in the Supplementary Appendix, available at NEJM.org.

 

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