Aashish Katapadi, Jalaj Garg, Nikhila Chelikam, Sudha Bommana, Luigi DiBiase, Donita Atkins, Rajesh Kabra, Douglas Darden, Peter Park, Naga Venkata K Pothineni, Rawan Albadareen, Syed Kazi, Rakesh Gopinathannair, Andrea Natale, Dhanunjaya Lakkireddy
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Patients underwent routine care (n = 36) with rate control or antiarrhythmic drugs or rhythm control with CA (n = 36) after discharge. Functional neurological outcomes at admission, discharge, and 6 and 12 months were measured using the modified Rankin score-a scoring system from 0 to 6, describing patient activity levels. AF-related outcomes are also measured.</p><p><strong>Results: </strong>Though the modified Rankin score was similar at admission (4.5 ± 1.0 vs 4.4 ± 1.0; P = 0.717) and discharge (4.23 ± 0.7 vs 4.2 ± 0.8; P = 0.656), it was lower at 6 months (2.0 ± 0.7 vs 3.5 ± 0.8; P < 0.001) and 12 months (1.1 ± 0.8 vs 3.0 ± 1.0; P < 0.001) for those that underwent CA. They also had a faster time to rhythm control (54.5 ± 15.6 days vs 73.1 ± 26.3 days; P < 0.001) and continued AF freedom at 12 months (100% vs 13.9%; P < 0.001), with fewer repeat strokes (0% vs 13.9%; P = 0.091), major bleeding (11.1% vs 25%; P = 0.126), number of hospitalizations (0.4 ± 0.8 vs 1.8 ± 1.5; P < 0.001), and mortality (0% vs 11.1%; P < 0.001).</p><p><strong>Conclusions: </strong>Early CA following the diagnosis of AF after a stroke is associated with significant improvement in neurologic outcomes, adverse events, and AF-related outcomes. Because of important differences in the study populations, it is uncertain whether these are directly attributable to early CA. Patients with stroke and AF may benefit from earlier CA, but additional studies are needed.</p>","PeriodicalId":14573,"journal":{"name":"JACC. 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Patients underwent routine care (n = 36) with rate control or antiarrhythmic drugs or rhythm control with CA (n = 36) after discharge. Functional neurological outcomes at admission, discharge, and 6 and 12 months were measured using the modified Rankin score-a scoring system from 0 to 6, describing patient activity levels. AF-related outcomes are also measured.</p><p><strong>Results: </strong>Though the modified Rankin score was similar at admission (4.5 ± 1.0 vs 4.4 ± 1.0; P = 0.717) and discharge (4.23 ± 0.7 vs 4.2 ± 0.8; P = 0.656), it was lower at 6 months (2.0 ± 0.7 vs 3.5 ± 0.8; P < 0.001) and 12 months (1.1 ± 0.8 vs 3.0 ± 1.0; P < 0.001) for those that underwent CA. They also had a faster time to rhythm control (54.5 ± 15.6 days vs 73.1 ± 26.3 days; P < 0.001) and continued AF freedom at 12 months (100% vs 13.9%; P < 0.001), with fewer repeat strokes (0% vs 13.9%; P = 0.091), major bleeding (11.1% vs 25%; P = 0.126), number of hospitalizations (0.4 ± 0.8 vs 1.8 ± 1.5; P < 0.001), and mortality (0% vs 11.1%; P < 0.001).</p><p><strong>Conclusions: </strong>Early CA following the diagnosis of AF after a stroke is associated with significant improvement in neurologic outcomes, adverse events, and AF-related outcomes. Because of important differences in the study populations, it is uncertain whether these are directly attributable to early CA. Patients with stroke and AF may benefit from earlier CA, but additional studies are needed.</p>\",\"PeriodicalId\":14573,\"journal\":{\"name\":\"JACC. 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引用次数: 0
摘要
背景：卒中后房颤（AF）管理不当与预后不良相关，早期心律控制与导管消融（CA）对这些患者神经预后的影响尚不清楚。目的：本研究旨在评估卒中时新发房颤患者早期心律控制与CA的影响。方法：我们对2021年至2023年住院的卒中和新发房颤患者进行了回顾性观察研究。患者出院后接受常规护理（n = 36），采用心率控制或抗心律失常药物或心律控制与CA （n = 36）。入院、出院、6个月和12个月的功能神经学结果使用改进的Rankin评分（一种评分系统，从0到6，描述患者的活动水平）进行测量。还测量了af相关的结果。结果：虽然改良的Rankin评分在入院时相似(4.5±1.0 vs 4.4±1.0；P = 0.717)和放电(4.23±0.7 vs 4.2±0.8；P = 0.656)， 6个月时较低(2.0±0.7 vs 3.5±0.8；P < 0.001)和12个月(1.1±0.8 vs 3.0±1.0;P < 0.001)。他们达到心律控制的时间也更快(54.5±15.6天vs 73.1±26.3天；P < 0.001)和12个月时房颤持续自由(100% vs 13.9%；P < 0.001)，重复卒中较少(0% vs 13.9%；P = 0.091)，大出血(11.1% vs 25%；P = 0.126)、住院次数(0.4±0.8 vs 1.8±1.5；P < 0.001)和死亡率(0% vs 11.1%；P < 0.001)。结论：卒中后房颤诊断后早期CA与神经系统预后、不良事件和房颤相关预后的显著改善相关。由于研究人群的重要差异，尚不确定这些差异是否直接归因于早期CA。卒中和房颤患者可能受益于早期CA，但需要进一步的研究。
Pilot Study of Early Catheter Ablation and Neurological Outcomes in Atrial Fibrillation-Related Stroke: RESCUE-STROKE.
Background: Inadequate management of atrial fibrillation (AF) after stroke is associated with a worse prognosis, and the impact of early rhythm control with catheter ablation (CA) on neurological outcomes in these patients is poorly understood.
Objectives: This study sought to evaluate the impact of early rhythm control with CA in patients with new-onset AF at the time of stroke.
Methods: We performed a retrospective, observational study of patients hospitalized with stroke and new-onset AF from 2021 to 2023. Patients underwent routine care (n = 36) with rate control or antiarrhythmic drugs or rhythm control with CA (n = 36) after discharge. Functional neurological outcomes at admission, discharge, and 6 and 12 months were measured using the modified Rankin score-a scoring system from 0 to 6, describing patient activity levels. AF-related outcomes are also measured.
Results: Though the modified Rankin score was similar at admission (4.5 ± 1.0 vs 4.4 ± 1.0; P = 0.717) and discharge (4.23 ± 0.7 vs 4.2 ± 0.8; P = 0.656), it was lower at 6 months (2.0 ± 0.7 vs 3.5 ± 0.8; P < 0.001) and 12 months (1.1 ± 0.8 vs 3.0 ± 1.0; P < 0.001) for those that underwent CA. They also had a faster time to rhythm control (54.5 ± 15.6 days vs 73.1 ± 26.3 days; P < 0.001) and continued AF freedom at 12 months (100% vs 13.9%; P < 0.001), with fewer repeat strokes (0% vs 13.9%; P = 0.091), major bleeding (11.1% vs 25%; P = 0.126), number of hospitalizations (0.4 ± 0.8 vs 1.8 ± 1.5; P < 0.001), and mortality (0% vs 11.1%; P < 0.001).
Conclusions: Early CA following the diagnosis of AF after a stroke is associated with significant improvement in neurologic outcomes, adverse events, and AF-related outcomes. Because of important differences in the study populations, it is uncertain whether these are directly attributable to early CA. Patients with stroke and AF may benefit from earlier CA, but additional studies are needed.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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