Europace：成功的导管消融可减少CHA2DS2-VASc评分≥1分房颤患者的心血管事件发生

房颤是临床常见的心律失常，是脑卒中发生的独立预测因子。近年来导管消融被认为是有症状者或药物治疗无效的房颤患者的有效治疗手段，然而目前大多数临床研究的随访时间均较短，且入选的患者多属低危，因此目前对于房颤患者成功导管消融能否改善患者的长期预后还不清楚。

目前的理论认为无症状的房颤患者较使用抗心律失常药物的患者具有更好的临床预后，因此我们认为导管消融后无房性心律失常发作可显着改善患者的临床症状，因此也可改善临床预后。为证明该项理论，Lin YJ等进行了一项大规模临床研究，旨在比较导管消融和抗心律失常药物对患者长期临床预后及死亡率的影响。

该研究共入选174例房颤导管消融患者，同时入选174例使用抗心律失常药物的房颤患者，所有患者均进行CHA2DS2-VASc评分。主要终点事件为主要心血管不良事件（MACE），包括死亡、心血管不良事件及手术相关血管并发症。通过长期随访结果如下：导管消融组的死亡率为0.74%，药物治疗组为2.95%；导管消融组心血管死亡率为0%，药物治疗组为1.77%；导管消融组缺血性脑卒中和TIA为0.59%，药物治疗组为0.59%。多因素Cox回归分析提示MACE发生的独立预测因子包括CHA2DS2-VASc评分高者，导管消融手术时间长者。对于接受导管消融治疗的患者，任何类型的房性心律失常复发预示着心血管事件及总死亡率的明显增加。

通过该项对照研究可得出以下结论：对于CHA2DS2-VASc评分≥1分的房颤患者，导管消融可显着减少总死亡率、心血管死亡率及心血管事件发生率，导管消融后房性心律失常复发与CHA2DS2-VASc评分一样，也是心血管事件发生的独立预测因子。

与导管消融相关的拓展阅读：

• JCE：既往存在胺碘酮相关甲亢的房颤患者导管消融后复发率较高
• Circulation：复杂性室性心律失常导管消融可改善患者长期预后
• CIRCULATION：非阵发性房颤患者导管消融的临床预后仍不理想
• NEJM述评：导管消融是治疗阵发性房颤的合理策略
• 房颤的导管消融治疗，证据级别、推荐等级全线升级——聚焦ESC2012 心房颤动治疗指南更新 更多信息请点击：有关导管消融更多资讯

Successful catheter ablation reduces the riskof cardiovascular events in atrial fibrillation patients with CHA2DS2-VASc risk score of 1 and higher

Aims
It is not known if successful catheter ablation for atrial fibrillation (AF) improves the patient's long-term cardiovascularoutcomes. This study investigated the long-term outcomes and mortalityof AF patients at high risk who received antiarrhythmic medication andcatheter ablation.
Methods and results
The propensity scores for AF were calculated for each patient and were used to assemble a cohort of 174 AF patients withablation who were compared with an equal number of AF patients without ablation. Composite cardiovascular end points (major adversecardiovascular event, MACE), including mortality and vascular events inthe medically treated patients representing the control group (group 1), were compared with those in the ablation-treated patients (group 2).The rates of the total mortality (2.95% vs. 0.74% per year; P < 0.01),cardiovascular death (1.77% vs. 0% per year; P = 0.001), and ischaemic stroke/transient ischaemic attack (2.21% vs. 0.59% per year; P = 0.02) were higher in group 1 than group 2, respectively. A multivariate Cox regression analysis of the MACE scores showed that a higher CHA2DS2-VASc score [hazard ratio (HR) = 1.309 per increment of score, 95% confidence interval (CI) = 1.06–1.617; P = 0.01] and the performance ofthe ablation procedure (HR = 0.225, CI = 0.076–0.671; P = 0.007) were independent predictors of a MACE. In patients who received catheterablation, recurrence of any atrial arrhythmia was a predictor of vascular events and total mortality (P < 0.05).
Conclusion
In AF patients with CHA2DS2-VASc score ≥1, catheterablation of AF reduced the risk of the total/cardiovascular mortality and total vascular events. Atrial fibrillation recurrence predicts long-termcardiovascular outcomes, as well as the CHA2DS2-VASc score.