射频消融与药物治疗对心房颤动合并心力衰竭患者的疗效差异比较

Comparison of Efficacy of Radiofrequency Ablation and Drug Therapy in Patients with Atrial Fibrillation Complicated with Heart Failure

目的比较在心房颤动(房颤)合并心力衰竭(心衰)患者中射频消融和药物治疗的疗效,以期为临床诊疗提供依据。方法回顾性分析2018年1月—2020年4月在天津医科大学总医院住院的88例房颤患者,其中男性53例,女性35例;射频消融组44例,药物治疗组44例。所有患者NYHA心功能分级Ⅱ级或Ⅲ级。随访期间主要观察患者的全因死亡、心血管死亡、心功能变化、心衰再入院率以及窦性心律维持率。同时比较随访12个月时的射血分数和左心房前后径变化。对于射血分数保留性心衰(HFpEF)患者,还观察了左心室质量指数的改变情况。结果在中位时间为12个月的随访中,射频消融组患者房颤复发率(P<0.001)和心衰再入院率(P=0.034)显著低于药物治疗组;射频消融组患者的生存率显著高于药物治疗组(P=0.007);术后不同随访时间点药物治疗组较射频消融组左心房前后径增大,且均随着随访的进行不断改善;在阵发性房颤患者中,接受射频消融治疗的患者射血分数随着随访的进行不断改善(P=0.017),在持续性房颤患者中,两组患者的射血分数均随着随访的进行不断改善。接受射频消融治疗的患者中,HFpEF和射血分数降低性心衰的患者在窦性心律维持率方面无显著差异(30.77%vs20.00%,P=1.000);两类患者的射血分数均随着随访的进行不断改善。在HFpEF患者中,术后的左心室质量指数无显著改善(P=0.104)。结论相比于药物治疗,射频消融能显著改善房颤合并心衰患者的心功能,降低患者的心衰再入院率以及死亡率,有效维持患者的窦性心律。

Objective To compare the efficacy of radiofrequency ablation and drug therapy in patients with atrial fibrillation complicated with heart failure,in order to provide a basis for clinical diagnosis and treatment.Methods A retrospective analysis was conducted on 88 patients with atrial fibrillation who admitted to the Department of Cardiology,Tianjin Medical University General Hospital from January 2018 to April 2020,including 53 males and 35 females,44 patients in the radiofrequency ablation group and 44 patients in the drug therapy group.All patients had NYHA cardiac function gradesⅡorⅢ.All cause death,cardiovascular death,changes in cardiac function,readmission to hospital for heart failure,and maintenance of sinus rhythm were observed during follow-up.At the same time,the changes of ejection fraction and left atrial anterior and posterior diameter were compared at 12 months of follow-up.Changes in left ventricular mass index(LVMI)were also observed in patients with heart failure with preserved ejection fraction(HFpEF).Results During the median follow-up of 12 months,the recurrence rate of atrial fibrillation(P<0.001)and the readmission rate of heart failure(P=0.034)in the radiofrequency ablation group were significantly lower than those in the drug therapy group.The survival rate in the radiofrequency ablation group was significantly higher than that in the drug therapy group(P=0.007).The left atrial diameter in the drug therapy group was larger than that in the radiofrequency ablation group at different follow-up time points,and all of them improved continuously with the follow-up.In patients with paroxysmal atrial fibrillation,the ejection fraction of patients receiving radiofrequency ablation improved continuously with the follow-up(P=0.017).In patients with persistent atrial fibrillation,the ejection fraction of both groups improved continuously with the follow-up.Among patients receiving radiofrequency ablation,there was no significant difference in sinus rhythm maintenance rate between patients with HFpEF and heart failure with reduced ejection fraction(30.77%vs 20.00%,P=1.000),and ejection fraction of both groups of patients improved continuously with follow-up.In patients with HFpEF,postoperative LVMI was not significantly improved(P=0.104).Conclusion Compared with drug therapy,radiofrequency ablation can significantly improve cardiac function in patients with atrial fibrillation complicated with heart failure,reduce the readmission rate and mortality rate of patients,and effectively maintain the sinus rhythm of patients.