有收缩功能障碍与无收缩功能障碍的心力衰竭患者心房颤动导管消融术后需要住院治疗的不良事件

Naoya Kataoka, T. Imamura, Takahisa Koi, Keisuke Uchida, K. Kinugawa
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引用次数: 0

摘要

背景:对于射血分数(EF)保留的心力衰竭(HF)患者,心房颤动(AF)消融术的安全性和有效性,尤其是术后需要住院治疗的不良事件(包括抗凝剂相关的大出血)的发生率,目前仍无定论。方法:回顾性审查了2019年至2022年期间在我院接受房颤导管消融术的房颤患者数据。根据基线左心室EF将所有参与者分为EF<50%组或EF≥50%组。比较了两组患者导管消融术后临床事件的综合发生率:(1)全因死亡;(2)高频住院;(3)卒中或全身性栓塞;(4)大出血。结果共纳入 122 名患者(75 岁,68 名男性)。其中 62 例(50.8%)患者的 EF 值≥50%。EF≥50%是综合终点的独立预测因素(调整后的几率比6.07,95%置信区间1.37-26.99,P = 0.018)。除了EF≥50%组的大出血发生率较高(12.7% vs. 0%,P = 0.026)外,两组的各种不良事件发生率无明显差异。结论在合并房颤的心房颤动患者中,EF≥50%患者房颤消融术后不良事件的发生率明显高于EF<50%的患者。这种差异主要源于 EF≥50% 组群中大出血发生率的升高。如何减少不良事件,尤其是 EF ≥ 50% 患者的不良事件,仍是下一个值得关注的问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adverse Events Requiring Hospitalization Following Catheter Ablation for Atrial Fibrillation in Heart Failure with versus without Systolic Dysfunction
Background: The safety and efficacy of atrial fibrillation (AF) ablation in individuals with heart failure (HF) with preserved ejection fraction (EF), particularly concerning the occurrence of post-procedural adverse events necessitating hospitalization, including anticoagulant-associated major bleeding, still lack conclusive determination. Methods: Data from patients with HF and AF who underwent catheter ablation for AF between 2019 and 2022 at our institution were retrospectively reviewed. All participants were divided into an EF < 50% group or an EF ≥ 50% group according to their baseline left ventricular EF. The composite incidence of the clinical events following catheter ablation was compared between the two groups: (1) all-cause death, (2) HF hospitalization, (3) stroke or systemic embolism, and (4) major bleeding. Results: A total of 122 patients (75 years old, 68 male) were included. Of them, 62 (50.8%) patients had an EF ≥ 50%. EF ≥ 50% was an independent predictor of the composite endpoint (adjusted odds ratio 6.07, 95% confidence interval 1.37–26.99, p = 0.018). The incidences of each adverse event were not significantly different between the two groups, except for a higher incidence of major bleeding in the EF ≥ 50% group (12.7% vs. 0%, p = 0.026). Conclusions: Among patients with HF coupled with AF, the incidence of adverse events following AF ablation proved notably elevated in patients with EF ≥ 50% in contrast to their counterparts with EF < 50%. This disparity primarily stems from a heightened occurrence of major bleeding within the EF ≥ 50% cohort. The strategy to reduce adverse events, especially in patients with EF ≥ 50%, remains the next concern.
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