肥厚型心肌病合并心房颤动的消融策略和预后分析
Catheter ablation strategy and long-term prognosis in patients with hypertrophic cardiomyopathy and atrial fibrillation
曹箫笛 1孙星星 2颜清 1陈红武 1蒋贞阳 1杨洁 1郦明芳 1陈明龙1
作者信息
- 1. 南京医科大学第一附属医院(江苏省人民医院)心内科,南京 210029
- 2. 南京医科大学第一附属医院(江苏省人民医院)心内科,南京 210029;南京医科大学康达医学院附属连云港市第二人民医院心内科,连云港 222006
- 折叠
摘要
目的 探究肥厚型心肌病(HCM)合并心房颤动(AF)患者的导管消融策略、心功能改善及长期窦性心律维持情况.方法 本研究为观察性研究,纳入2017年1月至2021年12月于南京医科大学第一附属医院住院治疗的HCM合并AF患者,根据治疗方式,分为AF导管消融组和药物保守治疗组.建立Logistic回归模型探究AF导管消融与心功能改善的相关性;建立Cox比例风险回归模型比较最后一次随访时消融与未消融患者生存率的差异.结果 纳入142例患者,年龄为(65.5±10.9)岁,其中男85例.随访期间,共15例患者失访,余患者随访39.5(23.3,56.0)个月.多因素Logistic回归模型结果示AF导管消融与HCM合并AF患者心功能改善相关(OR=3.55,95％CI 1.33～9.45,P=0.009);多因素Cox比例风险回归模型结果示AF导管消融能降低HCM合并AF患者的全因死亡风险(校正HR=0.13,95％CI 0.02～0.83,P=0.038);竞争风险模型中,AF导管消融能够降低HCM合并AF患者的心血管死亡风险(P=0.013).AF导管消融组中,消融术后12～24个月、24～36个月、36～48个月、48个月及以上的窦性心律维持率分别为87.5％、66.7％、66.7％和63.0％.对收集到的33例存在电压标测数据的患者进行亚组分析,结果提示左心房存在低电压区并进行基质改良的患者最后一次随访时窦性心律维持率与不存在低电压区患者相当(71.4％对73.3％,HfR=0.49,95％CI0.04～6.13,P=0.583).结论 AF导管消融术可以改善HCM合并AF患者的心功能,降低全因死亡及心血管死亡风险.HCM合并AF患者可能从个体化的基质改良中获益.
Abstract
Objective To investigate the catheter ablation strategy,improvement of cardiac function,and long-term sinus rhythm maintenance in patients with hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF).Methods This was an observational study that included patients with HCM and AF who were hospitalized at The First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021,and were divided into the AF catheter ablation group and the drug treatment group according to the treatment modality.The Logistic regression models were employed to explore the correlation between AF ablation and improvement in cardiac function.Additionally,the Cox proportional hazards regression models were utilized to compare the survival difference between ablated and unablated patients at the last follow-up.Results A total of 142 patients were included,with a mean age of(65.5±10.9)years,of whom 59.9％(85/142)were men.During the follow-up period,15 patients were lost to follow-up,and the median follow-up time of the remaining patients was 39.5(23.3,56.0)months.The results of multifactorial Logistic regression model showed that AF catheter ablation was associated with improved cardiac function in patients with HCM and AF(OR=3.55,95％CI 1.33-9.45,P=0.009).And multivariable Cox proportional hazards regression model suggested that AF ablation could reduce the risk of all-cause mortality(adjusted HR=0.13,95％CI 0.02-0.83,P=0.038).The risk of cardiovascular death in patients with HCM and AF was reduced by AF ablation in competing risk model(P=0.013).In AF ablation group,the rates of sinus rhythm maintenance at 12-24 months,24-36 months,36-48 months,and ≥48 months after ablation were 87.5％,66.7％,66.7％,and 63.0％,respectively.Subgroup analyses were performed on the 33 patients with voltage mapping data collected,and the results showed that the rate of sinus rhythm maintenance at last follow-up in patients with low-voltage area in the left atrium and substrate modification was comparable to that in patients without low-voltage area(71.4％vs.73.3％,HR=0.49,95％CI 0.04-6.13,P=0.583).Conclusion AF ablation can improve cardiac function and reduce the risk of all-cause and cardiovascular mortality in patients with HCM and AF.Patients with HCM and AF may benefit from individualized substrate modification.
关键词
心肌病,肥厚性/心房颤动/导管消融术/消融策略/预后分析Key words
Cardiomyopathy,hypertrophic/Atrial fibrillation/Catheter ablation/Ablation strategy/Prognostic analysis引用本文复制引用
基金项目
江苏省科技厅社会发展临床前沿技术项目(BE2017750)
国家自然科学基金(82270329)
出版年
2024
NETL
NSTL
万方数据