Comparison Of Prognostic Effects Of Rhythm Control And Heart Rate Control The Rapies In Heart Failure With Preserved Ejection Fraction Patients Complicated With Atrial Fibrillation

Objective:To analyze the comparison of rhythm control and rate control therapy on the prognosis of patients with heart failure with preserved ejection fraction（HFp EF）and atrial fibrillation（AF）.That is,the maintenance of sinus rhythm（SR）by catheter radiofrequency ablation combined with antiarrhythmic drugs is compared with ventricular rate control alone to analyze whether restoring and maintaining SR is associated with better clinical outcomes.So as to provide reference for the selection of clinical patient treatment plan.Methods:The patients with HFPEF diagnosed in Anhui provincial hospital from January2017 to September 2019 were retrospectively analyzed（meeting the HFPEF diagnostic criteria in the H₂FPEF scoring system,with a score greater than 5 points）,,while excluding the amino-terminal B-type natriuretic peptide precursor（N-terminal pro-B-type natriuretic peptide,NT-pro BNP）≤365pg/m L,and AF,as the study population.Finally,a total of 150 patients were included in this study,and the patients were divided into rhythm control group（n=75）and heart rate control group（n=75）according to different treatment regimens.The ablation strategy of all patients in the rhythm control group was circumferential pulmonary vein isolation.The rhythm control group was mainly treated with catheter radiofrequency ablation combined with antiarrhythmic drugs to maintain SR.The ablation strategy for all patients in the rhythm control group was circumferential pulmonary vein isolation.According to the AF diagnosis and management guidelines,in order to prevent the recurrence of AF,antiarrhythmic drugs should be taken prophylactically for 3 months after catheter radiofrequency ablation,and the need to continue to use antiarrhythmic drugs should be re-evaluated after 3 months.The heart rate control group was mainly treated with ventricular rate control drugs to achieve the control target of resting heart rate<110beats/min.The differences in clinical outcomes of the two groups of patients were analyzed and compared.Results:There were no significant differences in demographic data,NYHA functional class,CHA₂DS₂-VASc score,and comorbidities between the rhythm control group and the heart rate control group（P>0.05）.The median follow-up period of both groups was24 months.All patients in the rhythm control group were treated with antiarrhythmic drugs,and there was no significant difference in the other drug treatments between the two groups（P>0.05）,and there was no significant difference in biochemical indexes and echocardiographic parameters between the two groups（P>0.05）.Twelve patients died during the median follow-up period of 24 months,of which 9 were cardiovascular deaths and 3 were other causes of death.There was no significant difference in the mortality rates of all-cause and cardiovascular deaths between the two groups（P>0.05）;24patients were hospitalized for heart failure during the median follow-up period of 24months,and the incidence of heart failure hospitalization in the rhythm control group was significantly lower than that in the heart rate control group（P<0.05）.The NT-pro BNP and PASP in the rhythm control group were significantly decreased after 12 months of follow-up（P<0.05）,and there was no significant difference in LVEF after 12 months of follow-up compared with the baseline（P>0.05）;there was no significant difference in LVEF,NT-pro BNPand PASP compared with baseline after 12 months of follow-up（P>0.05）.Conclusion:For HFp EF patients with AF,compared with heart rate control therapy,rhythm control therapy can reduce the risk of hospitalization for HF,but the conclusion still needs to be verified by prospective clinical studies.