| BackgroundAtrial fibrillation(AF)and heart failure(HF)are two common diseases in the field of current heart diseases.With the improvement of living standard and aggravation of population aging,the incidence of atrial fibrillation and heart failure is on the rise,both of which have significantly increased global disease burden and health spending.Atrial fibrillation and heart failure often occur at the same time,cause and effect each other and form a vicious circle.More than a third of the patients with new atrial fibrillation have heart failure,and more than half of the patients with new atrial fibrillation have a higher risk of death when both are present.The current treatment of atrial fibrillation includes actively searching and controlling of primary diseases and inducements,controlling of ventricular rate treatment,maintaining sinus rhythm treatment.Controlling ventricular rate and maintaining sinus rhythm are the goal of practical traditional drug therapy in patients with atrial fibrillation.In the current guidelines,after fully controlling ventricular rate,sinus maintenance is recommended for patients with atrial fibrillation whose clinical symptoms have not been improved.Because atrial fibrillation in patients with heart failure are often associated with organic heart disease,and most of them are frequently complicated with contraindications to the use of traditional antiarrhythmic drugs(AADs),and the adverse effects of AADs and the uncertainty of its effect may offset the benefits of maintaining sinus rhythm.There is no clear optimal strategy for treating such p atients.Because of the limitations of AADs applications,clinicians turn their attention to non-drug maintenance sinus rhythm therapy,represented by radiofrequency catheter ablation(RFCA).ObjectiveThe purpose of this study was to study the effect of radiofrequency ablation on cardiac function and prognosis for persistent atrial fibrillation in patients with heart failure compared with antiarrhythmic drugs therapy.MethodsIn this study,a retrospective analysis was used to select a total of 157 persistent atrial fibrillation in patients with heart failure who were admitted to the first affiliated hospital of zhengzhou university from September 2017 to December 2018,including 75 patients with radiofrequency ablation therapy(ablation group),82 patients with antiarrhythm drugs therapy(drug group).Baseline data and follow-up data were collected for 3,6 and 12 months after discharge.The changes of left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left atrium diameter(LAD),the Minnesota Living with Heart Failure questionnaires(MLHFQ),N-terminal pro-B-type natriuretic peptide(NT-pro BNP),New York Heart Association(NYHA)class were analyzed at 3 months,6 months and 12 months.The recurrence of atrial fibrillation,re-hospitalization for heart failure and stroke/TIA were recorded in all patients,comparing the difference in prognosis between the two treatment methods.Results1.There was no significant difference in age,sex,duration of atrial fibrillation,history of hypertension,history of diabetes,history of coronary heart disease,history of stroke/TIA/thromboembolism,NYHA class,indexes of echocardiography,serological indexes,MLHFQ,resting heart rate,medication,CHA2DS2-VASc score between the two groups(p>0.05).2.Three months after discharge,LVEF of the ablation group was higher than the baseline data,and LVESV、LVEDV、LAD、NT-pro BNP、MLHFQ decreased compared with the baseline data,and the difference were statistically significant(p<0.05);LVEF、LVESV、LVEDV、LAD、NT-pro BNP、MLHFQ of the drug group did not change significantly compared with the baseline data,and the difference were not statistically significant(p>0.05).Six months after discharge,LVEF of the ablation group was higher than the baseline data,and LVESV、LVEDV、LAD、NT-pro BNP、MLHFQ were lower than the baseline data,and the difference were statistically significant(p<0.05);LVEF of the drug group was higher than the baseline data,and LVESV、LVEDV、LAD、NT-pro BNP、MLHFQ were lower than the baseline data,but the difference were not statistically significant(p>0.05).Twelve months after discharge,LVEF of the ablation group increased compared with the baseline data,and LVESV、LVEDV、LAD、NT-pro BNP、MLHFQ decreased compared with the baseline data,all of which were statistically significant(p<0.05);LVEF of the drug group increased compared with the baseline data,and LVESV、NT-pro BNP、MLHFQ decreased compared with the baseline data,all of which were statistically significant(p<0.05);the LVEDV、LAD decreased compared with the baseline data,but the difference were not statistically significant(p>0.05).3.Three months after discharge,LVEF、LVEDV、MLHFQ、NYHA class in the ablation group were significantly improved compared with the drug group(p<0.05);LVESV、NT-pro BNP、LAD difference between the two groups were not statistically significant(p>0.05).Six months after discharge,LVEF、LVESV、LVEDV、NT-pro BNP、MLHFQ、NYHA class in the ablation group were significantly improved compared with the drug group(p<0.05);the LAD difference between the two groups was not statistically significant(p>0.05).Twelve months after discharge,LVEF、LVESV、LVEDV、LAD、NT-pro BNP、MLHFQ、NYHA class were significantly improved compared with the drug group,and the difference were statistically significant(p<0.05).4.Three months after discharge,the number of people maintaining sinus rhythm in the ablation group was more than that in the drug group[(72,96.00%)vs(45,54.88%)],and the difference was statistically significant(p<0.05).Six months after discharge,the number of people maintaining sinus rhythm in the ablation group was more than that in the drug group[(68,90.67%)vs(33,40.24%)],and the difference was statistically significant(p<0.05).Twelve months after discharge,the number of people maintaining sinus rhythm in the ablation group was more than that in the drug group[(56,74.67%)vs(17,20.73%)],the number of people who was re-hospitalized for heart failure was less than that in the drug group[(14,18.67%)vs(31,37.80%)],and the number of strokes/TIA in the ablation group was less than that in the drug group[(2,2.67%)vs.(9,10.98%)],the difference were statistically significant(p<0.05).The Kaplan-Meier analysis showed a statistically significant difference in the survival rate of 12-month arrhythmia-free events between the two groups(Log Rank test:x2=54.609,p<0.05)and the 12-month readmission without heart failure survival rate was statistically significant between the two groups(Log Rank test:χ2=5.708,p<0.05).5.Multifactorial cox regression analysis revealed that age[HR=1.075,95%CI(1.007-1.148),p=0.031],LAD[HR=1.148,95%CI(1.024-1.287),p=0.018],duration of atrial fibrillation[HR=1.676,95%CI(1.228-2.287),p=0.001]were important risk factors for the recurrence of persistent atrial fibrillation after radiofrequency ablation.Conclusion1.Radiofrequency ablation can improve cardiac function for persistent atrial fibrillation in patients with heart failure.2.Radiofrequency ablation is more effective than antiarrhythmic drugs therapy for persistent atrial fibrillation in patients with heart failure.3.Compared with antiarrhythmic drugs therapy,radiofrequency ablation can effectively restore and maintain sinus rhythm for persistent atrial fibrillation in patients with heart failure,reduce the rate of re-hospitalization for heart failure and stroke/TIA,and improve the prognosis of patients.4.Age,LAD,and duration of atrial fibrillation for persistent atrial fibrillation in patients with heart failure are important risk factors for recurrence of atrial fibrillation after radiofrequency ablation. |
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