JACC:心房颤动及收缩期功能障碍患者导管消融与速率控制疗效对比

2017-08-28 MedSci MedSci原创

虽然有足够的速率控制,但心房颤动(AF)和左室收缩期功能障碍(LVSD)仍经常共存。之前的研究结果显示,对于并发AF和LVSD的患者来说恢复窦性节律是否有益还不清楚。近日,在医学权威杂志JACC上面发表了一篇研究文章,研究人员旨在探讨心房颤动(AF)导管消融(CA)vs.速率控制(MRC)是否能改善LVSD。

虽然有足够的速率控制,但心房颤动(AF)和左室收缩期功能障碍(LVSD)仍经常共存。之前的研究结果显示,对于并发AF和LVSD的患者来说恢复窦性节律是否有益还不清楚。近日,在医学权威杂志JACC上面发表了一篇研究文章,研究人员旨在探讨心房颤动(AF)导管消融(CA)vs.速率控制(MRC)是否能改善LVSD。

方法:
在2013年11月至2016年10月间,这项多中心随机临床试验纳入了66例持续性房颤和特发性心肌病(LVEF≤45%)患者。研究人员在对速率控制进行优化后,对患者行心脏MR(CMR)以评估LVEF和晚期钆增强(LGE),确定心室纤维化,并进行随机化分组:CA(n=33)或MRC(n=33),并以6个月LVEF改善情况作为主要终点。研究人员通过植入循环记录仪对CA后AF负荷进行评估,并通过连续的动态心动图来评估MRC的充分性。

结果:
CA后AF六个月的平均负荷为1.6%±5.0%。与MRC相比,CA组中LVEF以及心室和心房大小、心功能分级和BNP的减少有显着的改善。此外,MRI检测室性纤维化可预测LV的恢复程度。意向治疗分析显示,CA 组LVEF绝对改善+18±13%[vs.MRC组:+4.4±13%(p<0.0001)];标准化(LVEF≥50%)为58%[vs.MRC组:9%,p=0.0002]。CA组中LGE的缺失预测了LVEF的绝对改善(+10.7%,p=0.0069)以及6个月的正常化(73% vs.29%,p=0.0093)。

结论:
尽管有足够的速率控制,房颤是在这一人群中被低估的可逆转的LVSD的原因。导管消融(CA)使窦性节律恢复对心室功能有显着的改善,尤其是在CMR的心室纤维化缺失的情况下。这项研究挑战了“速率控制是AF和LVSD患者的恰当治疗策略”这一目前治疗模式。

Sandeep Prabhu,Andrew J. Taylor,Ben T. Costello,et al. Catheter Ablation Versus Medical Rate control in Atrial Fibrillation and Systolic Dysfunction (CAMERA-MRI). JACC. 2017 August.

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    2018-07-24 hbwxf
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    2017-08-30 sodoo

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用于心房颤动的放射性导管消融已经成为AF的重要治疗方法,然而其复发率仍然很高。近期,一项发表在杂志Circulation上的研究旨在确定积极降低血压(BP)是否能够防止房颤(AF)患者进行导管消融后房颤的复发和高症状的负担。研究者们随机分配184例AF和BP大于130/80 mmHg的患者在进行AF导管消融术前进行强化BP治疗(目标<120/80 mm Hg)或标准BP治疗(目标<14

Eur Heart J:导管消融治疗室上性心动过速的长期症状改善和患者满意度

SVT的消融治疗是一个安全的手术,在1年后对四分之三的患者带来症状改善和满意。即使在心律失常复发的患者中,也可以观察到高满意度和对消融机构的依赖。