导管射频消融与药物治疗房颤合并射血分数保留型心力衰竭患者临床疗效比较

Comparison of Clinical Efficacy of Radiofrequency Catheter Ablation and Drug Therapy in Patients with Atrial Fibrillation Complicated with Ejection Fraction Retention Heart Failure

摘要: 目的：分析比较导管射频消融术和药物治疗对心房颤动(Artrial fibrillation, AF)合并射血分数保留型心衰(Heart failure with preserved ejection fraction, HFpEF)患者的临床疗效。为临床患者治疗方案的制定提供一定的参考。方法：回顾性分析2018年1月~2020年6月在青岛大学附属医院住院的AF-HFpEF患者，选取339名作为研究人群。经spss26.0软件1:1倾向得分匹配(Propensity score matching, PSM)，最终确定192名患者，根据治疗方案的不同分为导管射频消融(Radiofrequency catheter ablation, RFCA)组(n = 96)和药物治疗(Drug treatment, DT)组(n = 96)。RFCA采用肺静脉隔离(Pulmonary vein isolation, PVI)、线性消融。药物治疗用药包括琥珀酸美托洛尔、比索洛尔、胺碘酮、地高辛等，使患者达到静息心率 < 110次/分的控制目标。随访观察30个月，主要终点事件为因心力衰竭(heart failure, HF)住院发生率。观察指标为两组患者氨基末端B型利钠肽前体(N-terminal prohormone of brain natriuretic peptide, NT-proBNP)、左房内径(Left atrial diameter, LAD)、左心室射血分数(Left ventricular ejection fraction, LVEF)、左室质量指数(Left ventricular mass index, LVMI)、左心室舒张早期二尖瓣血流最大速度/舒张早期二尖瓣环峰值速度(E/e’)、纽约心脏协会(New York heart association, NYHA)心功能分级。结果：RFCA组平均进行了1.1 ± 0.3次消融手术，无房性心律失常复发率为75 (78.1%)例，与DT组55 (57.3%)相比，差异有统计学意义(P < 0.05)。主要终点的因心衰住院率，RFCA组较DT组显著降低(HR 0.25, 95% CI: 0.1~0.62; P = 0.009)。RACA治疗后LVEF/LVMI、E/e’、NT-proBNP均较治疗前改善，差异有统计学意义(P < 0.05)；治疗后NYHA分级1 (1, 2)较治疗前降低，差异有统计学意义(P < 0.05)。DT组治疗后NYHA分级3 (1, 2)较治疗前增加，差异有统计学意义(P < 0.05)。结论：导管射频消融与药物治疗AF-HFpEF患者的房颤相比，导管射频消融可以降低因心衰住院率，减轻心力衰竭症状并改善心功能。

Abstract: Purpose: To analyze and compare the clinical efficacy of radiofrequency catheter ablation and drug therapy in patients with atrial fibrillation (AF) combined with preserved ejection fraction (HFpEF), to provide a certain reference for the formulation of clinical treatment program. Method: Retro-spective analysis. A total of 339 patients with AF-HFpEF who were hospitalized in the Affiliated Hos-pital of Qingdao University from January 2018 to June 2020 were retrospectively analyzed as the study population. A total of 192 patients were treated for Radiofrequency catheter ablation using spss26.0, a lot score matching (PSM). According to the different treatment regimens, they were di-vided into RFCA group (n = 96) and Drug treatment group (DT) (n = 96). RFCA uses Pulmonary vein isolation (PVI) and linear ablation. Medication included metoprolol succinate, Bisoprolol, amioda-rone, digoxin, etc., to achieve the resting heart rate < 110 beats/min control target. At 30 months of follow-up, the primary endpoint event was the incidence of hospitalization due to heart failure (HF). The observation indexes were N-terminal prohormone brain natriuretic peptide (NT-proBNP), Left atrial diameter (LAD), Left ventricular ejection fraction (LVEF), Left ventricular mass index (LVMI), maximum left ventricular mitral flow velocity in early diastolic period/Peak mitral ring velocity in early diastolic period (E/e’), and New York heart association (NYHA) cardiac function grading. Re-sults: In the RFCA group, 1.1 ± 0.3 ablation procedures were performed on average, and the recur-rence rate of atrial arrhythmia-free patients was 75 (78.1%), compared with 55 (57.3%) in the DT group, the difference was statistically significant (P < 0.05). Hospitalization for heart failure in the primary endpoint was significantly lower in the RFCA group than in the DT group (HR 0.25; 95% CI: 0.1~0.62; P = 0.009). After RACA treatment, LVEF/LVMI, E/e’, NT-proBNP were improved, and the difference was statistically significant (P < 0.05). NYHA grade 1 (1, 2) was lower after treatment than before, and the difference was statistically significant (P < 0.05). NYHA grade 3 (1, 2) was higher in DT group after treatment than before treatment, and the difference was statistically sig-nificant (P < 0.05). Conclusion: Radiofrequency catheter ablation can reduce hospitalization for heart failure, reduce symptoms of heart failure, and improve cardiac function compared with drug therapy for AF-HFpEF patients with atrial fibrillation.