心房颤动的心力衰竭患者将右心室起搏升级为双心室起搏的益处。

IF 7.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Europace Pub Date : 2024-07-02 DOI:10.1093/europace/euae179
Béla Merkely, Robert Hatala, Eperke Merkel, Mátyás Szigeti, Boglárka Veres, Alexandra Fábián, István Osztheimer, László Gellér, Michal Sasov, Jerzy K Wranicz, Csaba Földesi, Gábor Duray, Scott D Solomon, Valentina Kutyifa, Attila Kovács, Annamária Kosztin
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引用次数: 0

摘要

背景和目的:与窦性心律患者相比,心房颤动或扑动(AF)患者的心脏再同步化疗法(CRT)建议所依据的证据并不充分。我们的目的是在 BUDAPEST-CRT 升级试验人群中按其基线节律评估 CRT 升级的疗效。方法:射血分数降低(HFrEF)且之前已植入起搏器(PM)或植入式心律转复除颤器(ICD)且右室(RV)起搏负担≥20%的心衰患者被随机分配至 CRT-D 升级(n=215)或 ICD(n=145)。主要指标--[HF住院(HFH)、全因死亡率或结果:131名(36%)患者在入组时患有房颤,与窦性心律(SR)患者相比,他们发生高房颤的风险更高[调整后危险比(aHR)2.99;95%CI 1.26-7.13;P=0.013]。在平均 12.4 个月的随访时间内,CRT-D 升级对房颤患者和 SR 患者的效果相似[房颤调整后的几率比(aOR)为 0.06;95%CI 为 0.02 至 0.17;P'0.001;SR aOR 为 0.13;95%CI 为 0.07 至 0.27;P'0.001;交互作用 P=0.29]。此外,它还降低了高房颤或全因死亡的风险(aHR 0.33;95%CI 0.16 至 0.70;P=0.003;交互作用 P=0.17),并改善了超声心动图反应(左室舒张末期容积差 -49.21毫升;95%CI -69.10 至 -29.32;P'0.001;交互作用 P=0.21):在房颤合并 PM/ICD 且 RV 起搏负担较重的 HFrEF 患者中,与 ICD 相比,CRT-D 升级可降低 HFH 风险并改善反向重塑,这与 SR 患者的情况类似。
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Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation.

Aims: Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm.

Methods and results: Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).

Conclusion: In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.

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来源期刊
Europace
Europace 医学-心血管系统
CiteScore
10.30
自引率
8.20%
发文量
851
审稿时长
3-6 weeks
期刊介绍: EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.
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