AIMS:It is not known if successful catheter ablation for atrial fibrillation (AF) improves the patient's long-term cardiovascular outcomes. This study investigated the long-term outcomes and mortality of AF patients at high risk who received antiarrhythmic medication and catheter ablation.
METHODS AND RESULTS:The propensity scores for AF were calculated for each patient and were used to assemble a cohort of 174 AF patients with ablation who were compared with an equal number of AF patients without ablation. Composite cardiovascular end points (major adverse cardiovascular event, MACE), including mortality and vascular events in the medically treated patients representing the control group (group 1), were compared with those in the ablation-treated patients (group 2). The rates of the total mortality (2.95% vs. 0.74% per year; P < 0.01), cardiovascular death (1.77% vs. 0% per year; P = 0.001), and ischaemic stroke/transient ischaemic attack (2.21% vs. 0.59% per year; P = 0.02) were higher in group 1 than group 2, respectively. A multivariate Cox regression analysis of the MACE scores showed that a higher CHA2DS2-VASc score [hazard ratio (HR) = 1.309 per increment of score, 95% confidence interval (CI) = 1.06-1.617; P = 0.01] and the performance of the ablation procedure (HR = 0.225, CI = 0.076-0.671; P = 0.007) were independent predictors of a MACE. In patients who received catheter ablation, recurrence of any atrial arrhythmia was a predictor of vascular events and total mortality (P < 0.05).
CONCLUSION:In AF patients with CHA2DS2-VASc score ≥1, catheter ablation of AF reduced the risk of the total/cardiovascular mortality and total vascular events. Atrial fibrillation recurrence predicts long-term cardiovascular outcomes, as well as the CHA2DS2-VASc score.
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【Successful catheter ablation reduces the risk of cardiovascular events in atrial fibrillation patients with CHA2DS2-VASc risk score of 1 and higher.].
【成功的导管消融可降低CHA2DS2-VASc风险评分为1或更高的房颤患者发生心血管事件的风险。】
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DOI：10.1093/europace/eus336文章类型：杂志文章
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目的：尚不清楚成功的心房纤颤（AF）导管消融术能否改善患者的长期心血管结局。这项研究调查了接受抗心律不齐药物和导管消融治疗的高危房颤患者的长期预后和死亡率。
方法和结果：计算每位患者的房颤倾向评分，并用其汇总了174例房颤消融的房颤患者，与无消融的房颤患者进行比较。将复合心血管终点（主要不良心血管事件，MACE），包括代表对照组（第1组）的药物治疗患者的死亡率和血管事件，与消融治疗患者（第2组）进行了比较。总死亡率（每年2.95％比0.74％； P <0.01），心血管死亡（每年1.77％比0％； P = 0.001）和缺血性中风/短暂性脑缺血发作的发生率（2.21％比2％）。每年0.59％； P = 0.02）在第1组中分别高于第2组。 MACE分数的多变量Cox回归分析显示，CHA2DS2-VASc分数较高[危险比（HR）= 1.309 /分数递增，95％置信区间（CI）= 1.06-1.617； P = 0.01]和消融程序的执行情况（HR = 0.225，CI = 0.076-0.671； P = 0.007）是MACE的独立预测因子。在接受导管消融的患者中，任何心律失常的复发都是血管事件和总死亡率的预测指标（P <0.05）。
结论：在CHA2DS2-VASc评分≥1的房颤患者中，导管消融房颤可降低总/心血管死亡和总血管事件的风险。心房颤动的复发可预测长期的心血管结局，以及CHA2DS2-VASc评分。
方法和结果：计算每位患者的房颤倾向评分，并用其汇总了174例房颤消融的房颤患者，与无消融的房颤患者进行比较。将复合心血管终点（主要不良心血管事件，MACE），包括代表对照组（第1组）的药物治疗患者的死亡率和血管事件，与消融治疗患者（第2组）进行了比较。总死亡率（每年2.95％比0.74％； P <0.01），心血管死亡（每年1.77％比0％； P = 0.001）和缺血性中风/短暂性脑缺血发作的发生率（2.21％比2％）。每年0.59％； P = 0.02）在第1组中分别高于第2组。 MACE分数的多变量Cox回归分析显示，CHA2DS2-VASc分数较高[危险比（HR）= 1.309 /分数递增，95％置信区间（CI）= 1.06-1.617； P = 0.01]和消融程序的执行情况（HR = 0.225，CI = 0.076-0.671； P = 0.007）是MACE的独立预测因子。在接受导管消融的患者中，任何心律失常的复发都是血管事件和总死亡率的预测指标（P <0.05）。
结论：在CHA2DS2-VASc评分≥1的房颤患者中，导管消融房颤可降低总/心血管死亡和总血管事件的风险。心房颤动的复发可预测长期的心血管结局，以及CHA2DS2-VASc评分。
