Long‐term outcomes following catheter ablation versus medical therapy in patients with persistent atrial fibrillation and heart failure with reduced ejection fraction
| العنوان: | Long‐term outcomes following catheter ablation versus medical therapy in patients with persistent atrial fibrillation and heart failure with reduced ejection fraction |
|---|---|
| المؤلفون: | Rosita, Zakeri, Nikhil, Ahluwalia, Alexander, Tindale, Fatima, Omar, Matthew, Packer, Habib, Khan, Victoria, Baker, Shohreh, Honarbakhsh, Mark J, Earley, Simon, Sporton, Richard J, Schilling, David, Jones, Vias, Markides, Ross J, Hunter, Tom, Wong |
| المصدر: | European Journal of Heart Failure. 25:77-86 |
| بيانات النشر: | Wiley, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Cardiology and Cardiovascular Medicine |
| الوصف: | The ARC-HF and CAMTAF trials randomized patients with persistent atrial fibrillation (AF) and heart failure (HF) to early routine catheter ablation (ER-CA) versus pharmacological rate control (RC). After trial completion, delayed selective catheter ablation (DS-CA) was performed where clinically indicated in the RC group. We hypothesized that ER-CA would result in a lower risk of cardiovascular hospitalization and death versus DS-CA in this population.Overall, 102 patients were randomized (age 60 ± 11 years, left ventricular ejection fraction [LVEF] 31 ± 11%): 52 to ER-CA and 50 to RC. After 12 months, patients undergoing ER-CA had improved self-reported symptom scores, lower New York Heart Association class (i.e. better functional capacity), and higher LVEF compared to patients receiving RC alone. During a median follow-up of 7.8 (interquartile range 3.9-9.9) years, 27 (54%) patients in the RC group underwent DS-CA and 34 (33.3%) patients died, including 17 (32.7%) randomized to ER-CA and 17 (34.0%) randomized to RC. Compared with DS-CA, a strategy of ER-CA exhibited similar risk of all-cause mortality (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.44-1.77, p = 0.731) and combined all-cause mortality or cardiovascular hospitalization (aHR 0.80, 95% CI 0.43-1.47, p = 0.467). However, analyses according to treatment received suggested an association between CA and improved outcomes versus RC (all-cause mortality: aHR 0.43, 95% CI 0.20-0.91, p = 0.028; all-cause mortality/cardiovascular hospitalization: aHR 0.48, 95% CI 0.24-0.94, p = 0.031).In patients with persistent AF and HF, ER-CA produces similar long-term outcomes to a DS-CA strategy. The association between CA as a treatment received and improved outcomes means there is still a lack of clarity regarding the role of early CA in selected patients. Randomized trials are needed to clarify this question. |
| تدمد: | 1879-0844 1388-9842 |
| DOI: | 10.1002/ejhf.2714 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fca0ab815eca71662da9e0f238d81287 https://doi.org/10.1002/ejhf.2714 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....fca0ab815eca71662da9e0f238d81287 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 18790844 13889842 |
|---|---|
| DOI: | 10.1002/ejhf.2714 |