Catheter ablation vs antiarrhythmic therapy for atrial fibrillation in heart failure with preserved ejection fraction.

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY ACS Applied Materials & Interfaces Pub Date : 2024-10-22 DOI:10.1016/j.hrthm.2024.10.034

Marisa R DeLuca, Bilal Ali, Yasir Tarabichi, Beni R Verma, Saima Karim

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Abstract

Background: Clinical outcomes of patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) treated with catheter ablation (CA) vs antiarrhythmic therapy (AAT) are not well known.

Objective: This study compared morbidity and mortality of patients with AF and HFpEF treated with CA vs AAT.

Methods: AF and HFpEF patients from January 2017 to June 2023 were identified in TriNetX, a large global population-based database. Patients with prior diagnosis of heart failure with reduced ejection fraction (HFrEF) or crossover between AAT and CA were excluded. Baseline characteristics including age, sex, body mass index, type of AF, comorbidities, and cardiovascular medications were compared. The 2 groups were 1:1 propensity score matched for outcomes analysis. All-cause mortality, cerebrovascular accident/transient ischemic attack, and acute heart failure were compared with Kaplan-Meier curves.

Results: Patients treated with CA (n = 1959) and AAT (n = 7689) were 1:1 propensity score matched, yielding 3632 patients with no significant differences in baseline characteristics. Compared with AAT, CA was associated with decreased mortality (9.2% vs 20.5%; hazard ratio [HR], 0.431; 95% confidence interval [CI], 0.359-0.518; P < .001). In addition, CA was associated with reduced HFpEF (HR, 0.638; 95% CI, 0.550-0.741; P < .001) and acute HFrEF (HR, 0.645; 95% CI, 0.452-0.920; P = .015). There was no difference in composite of cerebrovascular accident/transient ischemic attack (HR, 0.935; 95% CI, 0.725-1.207; P = .607).

Conclusion: In this retrospective study of patients with AF and HFpEF, CA was associated with lower mortality and risk of acute heart failure compared with AAT.

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射血分数保留型心力衰竭患者心房颤动的导管消融与抗心律失常疗法的对比

背景：导管消融术（CA）与抗心律失常疗法（AAT）治疗心房颤动（AF）和射血分数保留型心力衰竭（HFpEF）患者的临床疗效并不为人所知：本研究比较了接受 CA 与 AAT 治疗的房颤和射血分数保留型心力衰竭患者的发病率和死亡率：2017年1月至2023年6月期间的房颤和高频心衰患者在全球大型人口数据库TriNetX中进行了识别。排除了之前诊断为 HFrEF 或在 AAT 和 CA 之间交叉的患者。比较了包括年龄、性别、体重指数、房颤类型、合并症和心血管药物在内的基线特征。两组患者按 1:1 的倾向匹配进行结果分析。用卡普兰-梅耶曲线比较全因死亡率、脑血管意外（CVA）/短暂性脑缺血发作（TIA）和急性高血压：接受CA治疗的患者（人数=1959）和接受AAT治疗的患者（人数=7689）按1:1的倾向匹配，结果显示，3632名患者的基线特征无显著差异。与 AAT 相比，CA 可降低死亡率（9.2% 对 20.5%；危险比 [HR]：0.431；95% 置信区间 [CI]：0.359至0.518；P结论：在这项针对房颤和高频心力衰竭患者的回顾性研究中，与 AAT 相比，CA 可降低死亡率和急性心力衰竭的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.