A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS

被引：131

作者：

Brignole, Michele ^{[1
]}

Pokushalov, Evgeny ^{[2
]}

Pentimalli, Francesco ^{[3
]}

Palmisano, Pietro ^{[4
]}

Chieffo, Enrico ^{[5
]}

Occhetta, Eraldo ^{[6
]}

Quartieri, Fabio ^{[7
]}

Calo, Leonardo ^{[8
]}

Ungar, Andrea ^{[9
]}

Mont, Lluis ^{[10
]}

Menozzi, Carlo

Alboni, Paolo

Bertero, Giovanni

Klersy, Catherine

Noventa, Franco

Brignole, M. ^{[11
]}

Oddone, D. ^{[11
]}

Donateo, O. ^{[11
]}

Maggi, R. ^{[11
]}

Croci, F. ^{[11
]}

Solano, A. ^{[11
]}

Pentimalli, F. ^{[12
]}

Palmisano, P. ^{[13
]}

Landolina, M. ^{[14
]}

Chieffo, E. ^{[14
]}

Taravelli, E. ^{[14
]}

Occhetta, E. ^{[15
]}

Quartieri, F. ^{[16
]}

Bottoni, N. ^{[16
]}

Iori, M. ^{[16
]}

Calo, L. ^{[17
]}

Sgueglia, M. ^{[17
]}

Pieragnoli ^{[18
]}

Giorni, A. ^{[18
]}

Nesti, M. ^{[18
]}

Giannini, I. ^{[18
]}

Ungar, A. ^{[18
]}

Padeletti, L. ^{[18
]}

Pokushalov, E. ^{[19
]}

Romanov, A. ^{[19
]}

Peregudov, I. ^{[19
]}

Vidorreda, S. ^{[20
]}

Nunez, R. ^{[20
]}

Mont, L. ^{[20
]}

机构：

[1] Osped Tigullio, Dept Cardiol, Via Don Bobbio, I-16033 Lavagna, Italy

[2] Novosibirsk Res Inst, Dept Cardiol, Novosibirsk, Russia

[3] Osped San Paolo, Dept Cardiol, Savona, Italy

[4] Osped Panico, Dept Cardiol, Tricase, Italy

[5] Osped Maggiore Crema, Dept Cardiol, Crema, Italy

[6] Osped Maggiore La Carita, Dept Cardiol, Novara, Italy

[7] Osped S Maria Nuova, Dept Cardiol, Reggio Emilia, Italy

[8] Policlin Casilino, Dept Cardiol, Rome, Italy

[9] Osped Careggi, Dept Cardiol, Florence, Italy

[10] Hosp Clin Barcelona, Dept Cardiol, Barcelona, Spain

[11] Osped Tigullio, Lavagna, Italy

[12] Osped San Paolo, Savona, Italy

[13] Osped Panico, Tricase, Italy

[14] Osped Maggiore Crema, Crema, Italy

[15] Osped Maggiore La Carita, Novara, Italy

[16] Osped S Maria Nuova, Reggio Emilia, Italy

[17] Policlin Casilino, Rome, Italy

[18] Osped Careggi, Florence, Italy

[19] Novosibirsk Res Inst, Novosibirsk, Russia

[20] Hosp Clin Barcelona, Barcelona, Spain

来源：

EUROPEAN HEART JOURNAL | 2018年 / 39卷 / 45期

关键词：

Atrial fibrillation; Heart failure; Cardiac resynchronization therapy; Catheter ablation; AV node ablation; QRS width; AV NODAL ABLATION; HEART-FAILURE; PHARMACOLOGICAL-TREATMENT; PACEMAKER; IMPLANTATION; EFFICACY; MODE;

D O I：

10.1093/eurheartj/ehy555

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS Methods and results We randomly assigned 102 patients (mean age 72 +/- 10 years) with severely symptomatic permanent AF (> 6 months), narrow QRS (<= 110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004). Conclusion AblationthornCRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS

引用

页码：3999 / 4008

页数：10

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