心房颤动合并中重度功能性二尖瓣反流:导管消融或药物治疗临床疗效的对比研究

Atrial fibrillation with moderate to severe functional mitral regurgitation:A comparative study of the clinical outcomes of catheter ablation versus drug therapy

目的:比较心房颤动(atrial fibrillation,AF)合并中、重度功能性二尖瓣反流(mitral regurgitation,MR)患者经导管消融或常规药物治疗的临床疗效,评估导管消融治疗对该类患者临床预后的影响。方法:回顾性分析在我院住院治疗的AF合并中、重度功能性MR的患者151例,根据其住院期间治疗方案分为导管消融组与药物治疗组。为避免两组基线差异对结果的影响,采用倾向性匹配方法,校正年龄、CHA_(2)DS_(2)-VASc评分、左室射血分数(left ventricular ejection fraction,LVEF)后,最终纳入43对共86例患者。观察指标为随访期间心力衰竭(心衰)相关住院及复合事件[心衰相关住院、卒中/短暂脑缺血发作(transient ischemic attack,TIA)]发生率。结果:随访期间,导管消融组心衰相关住院年发生率4.9%,卒中/TIA年发生率0%,复合事件年发生率4.9%;药物治疗组心衰相关住院年发生率15.3%,卒中/TIA年发生率1.4%,复合事件年发生率16.7%。随访21.5±8.8(3~36)个月,Kaplan-Meier生存曲线分析显示导管消融组心衰相关住院发生率(log-rank检验,P=0.043)及复合事件发生率(log-rank检验,P=0.026)均显著低于药物治疗组。多因素Cox回归分析发现,导管消融治疗(HR=0.27;95%CI:0.09~0.84;P=0.024)及基线存在心衰(HR=3.84;95%CI:1.07~13.74;P=0.038)是随访期间复合事件发生的独立预测因素。结论:AF合并中、重度功能性MR患者行导管消融治疗较常规药物治疗能显著降低临床事件发生率。

Objective:To compare the clinical efficacy of catheter ablation and conventional drug therapy in patients with atrial fibrillation(AF)complicated with moderate to severe functional mitral regurgitation(MR),and to evaluate the effect of catheter ablation on the clinical prognosis.Methods:This retrospective study included 151 consecutive patients with AF and moderate to severe functional MR.According to the treatment plan during hospitalization,all patients were divided into the catheter ablation group and drug therapy group.In order to avoid the impact of baseline differences between the two groups on the results,43 pairs of 86 patients were finally included after adjusting for age,CHA_(2)DS_(2)-VASc scores,and left ventricular ejection fraction(LVEF)using the propensity score matching method.The outcome measures were the incidence of heart failure-related hospitalization and composite events(heart failure-related hospitalization,stroke/transient ischemic attack[TIA])during follow-up.Results:During the follow-up period,the annual incidence of heart failure-related hospitalization,stroke/TIA,and composite events were 4.9%,0%,and 4.9%respectively in the catheter ablation group,while were 15.3%,1.4%,and 16.7%respectively in the drug therapy group.Followed up for 21.5±8.8(3-36)months,Kaplan-Meier survival curve analysis showed that the incidence of heart failure-related hospitalization(log-rank test,P=0.043)and composite events(log-rank test,P=0.026)in the catheter ablation group were significantly lower than those in the drug therapy group.Multivariate Cox regression analysis showed that catheter ablation(HR=0.27;95%CI:0.09-0.84;P=0.024)and baseline heart failure(HR=3.84;95%CI:1.07-13.74;P=0.038)were independent predictors of composite events during follow-up.Conclusion:Catheter ablation can significantly reduce the incidence of clinical events compared with conventional drug therapy in patients with AF complicated with moderate to severe functional MR.