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JACC:房颤和收缩功能不全中的导管消融术vs.心率控制

2017-09-12 xiangting MedSci原创

使用CA恢复窦性心律导致心室功能的显著改善,特别是在CMR不存在心室纤维化的情况下。

尽管心率得到充分控制,房颤(AF)和左心室收缩功能不全(LVSD)仍经常同时存在。现有关于不同病因AF和LVSD的随机研究已经显示出心率控制策略的益处。

这项研究目的是确定与医学心率控制(MRC)相比,AF的导管消融术(CA)是否可以改善LVSD,这里除了存在AF外,LVSD病因不明。

这项多中心随机临床试验纳入持续性房颤和特发性心肌病患者(LVEF≤45%)。在优化心率控制后,患者接受心脏MR(CMR)评估LVEF和晚期钆增强(LGE),指示心室纤维化,然后随机分配到CA或正在进行的MRC。CA包括PVI和后壁分离。通过植入环路记录仪评估CA后AF负荷,并通过Holter监测评估MRC。主要终点为6个月时重复 CMR的ΔLVEF。

对 301例患者进行了筛查,2013年11月至2016年10月期间共纳入了68例患者,随机分为每组33例,2例中途退出。6个月时CA后平均AF负担为1.6%±5.0%。在治疗意图分析方面,CA组绝对LVEF升高+18±13%,MRC组为+4.4±13%(p <0.0001)和正常率(LVEF≥50%)分别为58%和9% p = 0.0002。在接受CA治疗的患者中,缺乏LGE预测了6个月时的绝对LVEF(+ 10.7%,p = 0.0069)和正常值(73%vs 29%,p = 0.0093)有更大改善。

在这个人群中AF是LVSD的一个被低估的可逆病因,尽管充分的心率控制。使用CA恢复窦性心律导致心室功能的显著改善,特别是在CMR不存在心室纤维化的情况下。这对目前心率控制是AF和LVSD患者适当策略的治疗范式提出了挑战。

原始出处:

Sandeep Prabhu, et al. Catheter Ablation Versus Medical Rate control in AtrialFibrillation and Systolic Dysfunction (CAMERA-MRI). JACC. 27 August 2017. 

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

 

 

 

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    2018-06-20 hbwxf
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  5. 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  7. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243311, encodeId=03e72433114c, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Sep 12 19:58:51 CST 2017, time=2017-09-12, status=1, ipAttribution=)]
  8. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243311, encodeId=03e72433114c, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Sep 12 19:58:51 CST 2017, time=2017-09-12, status=1, ipAttribution=)]
  9. 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content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Thu Sep 14 07:57:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243438, encodeId=444f2434386d, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Wed Sep 13 06:04:30 CST 2017, time=2017-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243311, encodeId=03e72433114c, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Sep 12 19:58:51 CST 2017, time=2017-09-12, status=1, ipAttribution=)]
    2017-09-13 天涯183

    非常好的文章.学习了

    0

  10. 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content=<a href='/topic/show?id=a9fd65826da' target=_blank style='color:#2F92EE;'>#消融术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65826, encryptionId=a9fd65826da, topicName=消融术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4415117207, createdName=dingxiaobo, createdTime=Thu Sep 14 07:57:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243438, encodeId=444f2434386d, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Wed Sep 13 06:04:30 CST 2017, time=2017-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243311, encodeId=03e72433114c, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Sep 12 19:58:51 CST 2017, time=2017-09-12, status=1, ipAttribution=)]
    2017-09-12 王秀

    学习了.涨知识了!

    0

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导管消融术在持续性房颤的应用中不如在阵发性房颤中的应用中的效果好。指南建议,在持续性心房颤中,除了隔离肺静脉,辅助底物也需要改变。    因此,研究人员对589例持续房颤患者以1:4:4的比例随机分配,即是消融与单独肺静脉隔离(67例),肺静脉隔离电描示出复杂碎裂活性加消融(263例),在整个左心房顶部和二尖瓣峡部肺静脉电隔离以及附加线性消融(259例)。随访时间为1

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