[1]徐尧 蔡衡 李洪仕.射频消融与药物治疗对心房颤动合并心力衰竭患者的疗效差异比较[J].心血管病学进展,2022,(3):274-281.[doi:10.16806/j.cnki.issn.1004-3934.2022.03.000]
点击复制

射频消融与药物治疗对心房颤动合并心力衰竭患者的疗效差异比较()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年3期
页码:
274-281
栏目:
论著
出版日期:
2022-03-25

文章信息/Info

文章编号:
202108067
作者:
徐尧 蔡衡 李洪仕
(天津医科大学总医院心内科,天津 300052)
Author(s):
?Department of Cardiology,Tianjin Medical University General Hospital,Tianjin 300052,China)
关键词:
心房颤动; 心力衰竭; 射频消融
Keywords:
Atrial fibrillation; Heart failure; Radiofrequency ablation
DOI:
10.16806/j.cnki.issn.1004-3934.2022.03.000
摘要:
目的 比较在心房颤动（房颤）合并心力衰竭（心衰）患者中射频消融与药物治疗的疗效，以期为临床诊疗提供依据。方法 回顾性分析2018年1月—2020年4月在天津医科大学总医院住院的88例房颤患者，其中男性53例，女性35例，射频消融组44例，药物治疗组44例。所有患者NYHA心功能分级Ⅱ级和Ⅲ级。随访期间主要观察患者的全因死亡、心血管死亡、心功能变化、心衰再入院率以及窦性心律维持率。同时比较随访12个月时的射血分数、左房前后径变化。对于射血分数保留性心衰（HFpEF）患者，还观察了左心室质量指数的改变情况。结果 在中位时间为12个月的随访中，射频消融组患者房颤复发率（P＜0.001）和心衰再入院率（P＝0.034）显著低于药物治疗组；射频消融组患者的生存率显著高于药物治疗组（P＝0.007）；术后不同随访时间点药物治疗组较射频消融组左房前后径增大,且均随随访的进行不断改善；在阵发性房颤患者中，接受射频消融治疗的患者射血分数随随访的进行不断改善（P＝0.017），在持续性房颤患者中，两组患者的射血分数均随随访的进行不断改善。接受射频消融治疗的患者中，HFpEF和射血分数降低性心衰的患者在窦性心律维持率方面无显著差异（30.77% vs 20.00%,P＝1.000）；两类患者的射血分数均随随访的进行不断改善。在HFpEF患者中，术后的左心室质量指数无显著改善（P＝0.104）。结论 相比于药物治疗，射频消融能显著改善房颤合并心衰患者的心功能，降低患者的心衰再入院率以及死亡率，有效维持患者的窦性心律。
Abstract:
Objective To compare the efficacy of radiofrequency ablation and drug therapy in patients with atrial fibrillation complicated with heart failure,in order to provide a basis for clinical diagnosis and treatment. Methods A retrospective analysis was conducted on 88 patients with atrial fibrillation who admitted to the Department of Cardiology,Tianjin Medical University General Hospital from January 2018 to April 2020,including 53 males and 35 females,44 patients in the radiofrequency ablation group and 44 patients in the drug therapy group. All patients had NYHA cardiac function grades Ⅱ and Ⅲ . All cause death,cardiovascular death,changes in cardiac function,readmission to hospital for heart failure,and maintenance of sinus rhythm were observed during follow-up. At the same time,the changes of ejection fraction and left atrial anterior and posterior diameter were compared at 12 months of follow-up. Changes in left ventricular mass index(LVMI) were also observed in patients with heart failure with preserved ejection fraction(HFpEF). Results During the median follow-up of 12 months,the recurrence rate of atrial fibrillation(P＜0.001) and the readmission rate of heart failure(P＝0.034) in the radiofrequency ablation group were significantly lower than those in the drug therapy group. The survival rate in the radiofrequency ablation group was significantly higher than that in the drug therapy group(P＝0.007). The left atrial diameter in the drug therapy group was larger than that in the radiofrequency ablation group at different follow-up time points,and all of them improved continuously with the follow-up. In patients with paroxysmal atrial fibrillation,the ejection fraction of patients receiving radiofrequency ablation improved continuously with the follow-up(P=0.017). In patients with persistent atrial fibrillation,the ejection fraction of both groups improved continuously with the follow-up. Among patients receiving radiofrequency ablation,there was no significant difference in sinus rhythm maintenance rate between patients with HFpEF and heart failure with reduced ejection fraction(30.77% vs 20.00%,P＝1.000). And ejection fraction of both groups of patients improved continuously with follow-up. In patients with HFpEF,postoperative LVMI was not significantly improved(P＝0.104). Conclusion Compared with drug therapy,radiofrequency ablation can significantly improve cardiac function in patients with atrial fibrillation complicated with heart failure,reduce the readmission rate and mortality rate of patients,and effectively maintain the sinus rhythm of patients.

参考文献/References:

[1]Wyse DG,Waldo AL,Dimarco JP,et al. A comparison of rate control and rhythm control in patients with atrial fibrillation[J]. N Engl J Med,2002,347(23):1825-1833.

[2]van Gelder IC,Hagens VE,Bosker HA,et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation[J]. N Engl J Med,2002,347(23):1834-1840.

[3]Roy D,Talajic M,Nattel S,et al. Rhythm control versus rate control for atrial fibrillation and heart failure[J]. N Engl J Med,2008,358(25):2667-2677.

[4]Marrouche NF,Brachmann J,CASTLE-AF Steering Committee. Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation(CASTLE-AF)—Study design[J]. Pacing Clin Electrophysiol,2009,32(8):987-994.

[5]Hindricks G,Potpara T,Dagres N,et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS):the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology(ESC) Developed with the special contribution of the European Heart Rhythm Association(EHRA) of the ESC[J]. Eur Heart J,2021,42(5):373-498.

[6]Pieske B,Tsch?pe C,de Boer RA,et al. How to diagnose heart failure with preserved ejection fraction:the HFA-PEFF diagnostic algorithm:a consensus recommendation from the Heart Failure Association(HFA) of the European Society of Cardiology(ESC)[J]. Eur Heart J,2019,40(40):3297-3317.

[7]Ponikowski P,Voors AA,Anker SD,et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC) Developed with the special contribution of the Heart Failure Association(HFA) of the ESC[J]. Eur Heart J,2016,37(27):2129-2200.

[8]Marrouche NF,Brachmann J,Andresen D,et al. Catheter ablation for atrial fibrillation with heart failure[J]. N Engl J Med,2018,378(5):417-427.

[9]di Biase L,Mohanty P,Mohanty S,et al. Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device[J]. Circulation,2016,133(17):1637-1644.

[10]Hunter RJ,Berriman TJ,Diab I,et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure(the CAMTAF trial)[J]. Circ Arrhythm Electrophysiol,2014,7(1):31-38.

[11]Kuck KH,Merkely B,Zahn R,et al. Catheter ablation versus best medical therapy in patients with persistent atrial fibrillation and congestive heart failure:the randomized AMICA trial[J]. Circ Arrhythm Electrophysiol,2019,12(12):e007731.

[12]Prabhu S,Taylor AJ,Costello BT,et al. Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction:the CAMERA-MRI study[J]. J Am Coll Cardiol,2017,70(16):1949-1961.

[13]Machino-Ohtsuka T,Seo Y,Tada H,et al. Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation[J]. J Cardiovasc Electrophysiol,2011,22(9):999-1006.

[14]Kelly JP,Devore AD,Wu J,et al. Rhythm control versus rate control in patients with atrial fibrillation and heart failure with preserved ejection fraction:insights from get with the guidelines—Heart failure[J]. J Am Heart Assoc,2019,8(24):e011560.

[15]Aldaas OM,Lupercio F,Darden D,et al. Meta-analysis of the usefulness of catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction[J]. Am J Cardiol,2021,142:66-73.

相似文献/References:

[1]贺鹏康,周菁.心房颤动治疗新技术——冷冻球囊消融[J].心血管病学进展,2016,(1):1.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.001]
　HE Pengkang,ZHOU Jing.Cryoballoon Ablation, A Novel Technology for Atrial Fibrillation Treatment[J].Advances in Cardiovascular Diseases,2016,(3):1.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.001]
[2]都明辉,施海峰*,佟佳宾,等.心房颤动消融相关性无症状性脑缺血[J].心血管病学进展,2016,(1):3.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.002]
　DU Minghui,SHI Haifeng*,TONG Jiabin,et al.Silent Cerebral Ischemia Related to Atrial Fibrillation Ablation[J].Advances in Cardiovascular Diseases,2016,(3):3.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.002]
[3]丁娟,刘地川.心力衰竭与线粒体功能障碍的研究进展[J].心血管病学进展,2016,(1):84.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.022]
　DING Juan,LIU Dichuan.Research Progress of Heart Failure and Mitochondrial Dysfunction[J].Advances in Cardiovascular Diseases,2016,(3):84.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.022]
[4]郑环杰,综述,肖骅,等.心房颤动抗栓治疗研究进展[J].心血管病学进展,2016,(2):142.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.012]
　ZHENG Huanjie,XIAO Hua.Progress of Antithrombotic Therapy in Patients with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(3):142.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.012]
[5]张清,综述,罗素新,等.新型Xa 因子抑制剂———依度沙班在心房颤动患者抗凝治疗中的研究进展[J].心血管病学进展,2016,(2):151.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.014]
　ZHANG Qing,LUO Suxin,TANG Jiong.Novel Factor Xa Inhibitors—Edoxaban in Prevention of Stroke in Patients with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(3):151.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.014]
[6]胡红玲,综述,罗素新,等.预防非瓣膜性心房颤动性脑卒中的治疗新进展[J].心血管病学进展,2016,(3):250.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.009]
　HU Hongling,LUO Suxin.New Progress in the Treatment for Cerebral Apoplexy of Nonvalvular Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(3):250.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.009]
[7]王超,杨国澍,综述,等.关附甲素治疗心房颤动的研究进展[J].心血管病学进展,2016,(3):254.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.010]
　WANG Chao,YANG Guoshu,CAI Lin,et al.Research Progress of the Treatment of Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(3):254.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.010]
[8]罗秀林,综述,张烁,等.肾动脉去交感神经术治疗心力衰竭——希望还是炒作[J].心血管病学进展,2016,(3):268.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.013]
　LUO Xiulin,ZHANG Shuo.Renal Sympathetic Denervation for Heart Failure—Hopes or Hypes[J].Advances in Cardiovascular Diseases,2016,(3):268.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.013]
[9]查凤艳,综述,覃数,等.心源性恶病质发病机制的研究进展[J].心血管病学进展,2016,(3):282.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.017]
　ZHA Fengyan,QIN Shu.Advances in Pathogenesis of Cardiac Cachexia[J].Advances in Cardiovascular Diseases,2016,(3):282.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.017]
[10]李慧,综述,齐国先,等.老年射血分数保留的心功能不全研究进展[J].心血管病学进展,2016,(4):354.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.007]
　LI Hui,QI Guoxian.Research Progress of Heart Failure with Preserved Ejection Fraction in Elderly People[J].Advances in Cardiovascular Diseases,2016,(3):354.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.007]
[11]吴彤 高东来.心房颤动合并心力衰竭的射频消融治疗[J].心血管病学进展,2019,(5):757.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.023]
　WU TongGAO Donglai.Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure[J].Advances in Cardiovascular Diseases,2019,(3):757.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.023]
[12]鲁星琴 莫乔莹 陈凤梅 姚亚丽.睡眠呼吸障碍与心力衰竭并发心房颤动的相关性研究现状[J].心血管病学进展,2020,(2):182.[doi:10.16806/j.cnki.issn.1004-3934.2020.02.021]
　LU Xingqin,MO Qiaoying,CHENG Fengmei,et al.Research Status of Association Between Sleep-disordered Breathing and Atrial Fibrillation in Patients with Heart Failure[J].Advances in Cardiovascular Diseases,2020,(3):182.[doi:10.16806/j.cnki.issn.1004-3934.2020.02.021]
[13]史云聪,王立立 郭艺芳.维生素D与心血管疾病相关性研究进展[J].心血管病学进展,2020,(8):826.[doi:10.16806/j.cnki.issn.1004-3934.20.08.011]
　SHI YuncongWANG LiliGUO Yifang.Vitamin D And Cardiovascular Disease[J].Advances in Cardiovascular Diseases,2020,(3):826.[doi:10.16806/j.cnki.issn.1004-3934.20.08.011]
[14]李英  刘兴鹏.常见心血管病服药依从性[J].心血管病学进展,2020,(10):1016.[doi:10.16806/j.cnki.issn.1004-3934.2020.10.000]
　LI Ying,LIU Xingpeng.Medication Adherence For Common Cardiovascular Diseases[J].Advances in Cardiovascular Diseases,2020,(3):1016.[doi:10.16806/j.cnki.issn.1004-3934.2020.10.000]
[15]刘玉辉 王盼盼 陈椿.心房颤动性心肌病临床研究进展[J].心血管病学进展,2020,(12):1238.[doi:10.16806/j.cnki.issn.1004-3934.2020.12.004]
　LIU Yuhui,WANG Panpan,CHEN Chun.Atrial Fibrillation-induced Cardiomyopathy[J].Advances in Cardiovascular Diseases,2020,(3):1238.[doi:10.16806/j.cnki.issn.1004-3934.2020.12.004]
[16]徐尧 蔡衡 李洪仕.心房颤动合并心力衰竭的导管消融治疗[J].心血管病学进展,2021,(4):322.[doi:10.16806/j.cnki.issn.1004-3934.2021.04.009]
　XU Yao,CAI Heng,LI Hongshi.Role of Radiofrequency Ablation in Patients with Atrial Fibrillation and Heart Failure[J].Advances in Cardiovascular Diseases,2021,(3):322.[doi:10.16806/j.cnki.issn.1004-3934.2021.04.009]
[17]乔宝 魏述建.心房衰竭的临床研究进展[J].心血管病学进展,2024,(1):57.[doi:10.16806/j.cnki.issn.1004-3934.2024.01.015]
　QIAO Bao,WEI Shujian.Progress of Clinical Research on Atrial Failure[J].Advances in Cardiovascular Diseases,2024,(3):57.[doi:10.16806/j.cnki.issn.1004-3934.2024.01.015]
[18]陈建福 陈灿.血压目标范围内时间与心血管疾病关系的研究进展[J].心血管病学进展,2024,(7):617.[doi:10.16806/j.cnki.issn.1004-3934.2024.07.010]
　CHEN Jianfu,CHEN Can.The Relationship Between Time in Target Range and Cardiovascular Disease[J].Advances in Cardiovascular Diseases,2024,(3):617.[doi:10.16806/j.cnki.issn.1004-3934.2024.07.010]
[19]张琛玥 芦颜美 汤宝鹏.心房肺静脉牵张在慢性心力衰竭合并心房颤动中的作用与相关治疗的研究进展[J].心血管病学进展,2024,(10):897.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.007]
　ZHANG Chenyue,LU Yanmei,TANG Baopeng?/html>.The Role and Related Treatment of Atrial Pulmonary Vein Stretch in Chronic Heart Failure Complicated with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2024,(3):897.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.007]

更新日期/Last Update: 2022-04-22