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【medical-news】在低射血分数的心衰患者中使用肺静脉窦隔离初见成效

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PVI shows promise in low EF CHF
Atrioventricular (**) node ablation has been used to treat symptomatic atrial fibrillation with poor rate control, although these studies have contained few subjects with low ejection fractions (EFs). Biventricular pacing has recently been shown to be better than right ventricular pacing after ** node ablation.

The Pulmonary Vein Antrum Isolation (PVI) versus ** Node Ablation with Biventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA-CHF) trial aimed to compare PVI with ** node ablation and biventricular pacing in patients with an EF <40%, symptomatic atrial fibrillation and NYHA class II–III heart failure. This was a prospective multicentre randomised controlled trial. The primary end point was a composite of EF, distance on a 6-min walk test and Minnesota Living with Heart Failure Questionnaire (MLWHF) score. Follow-up was performed with a loop event monitor that patients wore from months 2 to 6 after the procedure. Patients recorded any symptoms and recorded at least 2–3 transmissions/week, even if they were asymptomatic.

Forty-one patients underwent PVI and 40 ** node ablation with biventricular pacing. The composite primary end point favoured patients undergoing PVI with an improved questionnaire score at 6 months (p<0.001), a longer 6-min walk test (340 m vs 297 m, p<0.001) and a higher EF (35% vs 28%, p<0.001). Eighty-eight per cent of patients receiving antiarrhythmic drugs in the PVI group, and 71% not receiving these agents, were free of atrial fibrillation at 6 months. In the PVI group, two patients developed pulmonary stenosis, one a pericardial effusion and one pulmonary oedema. In the ** node ablation and biventricular pacing arm, lead displacement occurred in one patient and one had a pneumothorax.

The AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial was a landmark study that has been argued to show a benefit of rate control over a rhythm control strategy. However, subsequent analysis of the data demonstrated that rhythm control with restoration of sinus rhythm conferred survival benefit. PVI (arguably a form of rhythm control) in this trial had a good success rate and resulted in better morphological and functional outcomes than the optimal rate control strategy (** node ablation and biventricular pacing). A hundred per cent of patients in the ** node ablation and pacing arm had atrial fibrillation at 3 and 6 months—an unexpected finding.

Although this study is limited by the short follow-up data and the fact that the procedures were all performed in very experienced centres, it nonetheless provides strong support for PVI in centres with the appropriate experience.

Khan MN, Jais P, Cummings J, . Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 2008;359:1778–85.

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2009-01-30 11:36 浏览 : 897 回复 : 3

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2009-02-15 23:36

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PVI shows promise in low EF CHF
在低射血分数的充血性心衰患者中使用肺静脉隔离有效
Atrioventricular (**) node ablation has been used to treat symptomatic atrial fibrillation with poor rate control, although these studies have contained few subjects with low ejection fractions (EFs). Biventricular pacing has recently been shown to be better than right ventricular pacing after ** node ablation.
尽管一些研究包括少数低射血分数的患者，房室结消融仍习惯上用于治疗有症状的房颤患者控制节律。近来，双室起搏表现出比房室结消融后的右室起搏更佳的效果。
The Pulmonary Vein Antrum Isolation (PVI) versus ** Node Ablation with Biventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA-CHF) trial aimed to compare PVI with ** node ablation and biventricular pacing in patients with an EF <40%, symptomatic atrial fibrillation and NYHA class II–III heart failure. This was a prospective multicentre randomised controlled trial. The primary end point was a composite of EF, distance on a 6-min walk test and Minnesota Living with Heart Failure Questionnaire (MLWHF) score. Follow-up was performed with a loop event monitor that patients wore from months 2 to 6 after the procedure. Patients recorded any symptoms and recorded at least 2–3 transmissions/week, even if they were asymptomatic.
肺静脉窦隔离和双室起搏的房室结消融术在治疗房颤合并充血性心力衰竭的患者时的比较实验，目的是比较肺静脉隔离与房室结消融加双室起搏在射血分数<40%、有症状的房颤、纽约心功能分级II–III级的心衰患者中的治疗效果。这是个前瞻、多中心随机对照试验。主要终点事件是射血分数、6分钟步行实验、明尼苏达生活质量分数的复合。以术后2-6个月患者携带的环状事件监测器记录随访，其可记录患者每一症状，即使没有任何症状的情况下，每周也至少记录2-3次。
Forty-one patients underwent PVI and 40 ** node ablation with biventricular pacing. The composite primary end point favoured patients undergoing PVI with an improved questionnaire score at 6 months (p<0.001), a longer 6-min walk test (340 m vs 297 m, p<0.001) and a higher EF (35% vs 28%, p<0.001). Eighty-eight per cent of patients receiving antiarrhythmic drugs in the PVI group, and 71% not receiving these agents, were free of atrial fibrillation at 6 months. In the PVI group, two patients developed pulmonary stenosis, one a pericardial effusion and one pulmonary oedema. In the ** node ablation and biventricular pacing arm, lead displacement occurred in one patient and one had a pneumothorax.
总计41为接受肺静脉隔离和40位接受房室结消融加双室起搏的患者。复合主要终点事件在接受肺静脉隔离的患者表现的更佳，其6个月的生活质量分数提高(p<0.001)、6分钟步行试验延长(与房室结消融加双室起搏比较340 m比297 m, p<0.001)、射血分数增加(35% 比28%, p<0.001)。在肺静脉隔离组，88%的患者服用了抗心律失常药物，没有服用抗心律失常药的患者中的71%，在其后6个月没有发生房颤。在肺静脉隔离治疗组中，2人出现肺静脉狭窄，1人出现心包积液，1人出现肺水肿。在房室结消融加双室起搏组，1人导联置换，1人气胸。
The AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial was a landmark study that has been argued to show a benefit of rate control over a rhythm control strategy. However, subsequent analysis of the data demonstrated that rhythm control with restoration of sinus rhythm conferred survival benefit. PVI (arguably a form of rhythm control) in this trial had a good success rate and resulted in better morphological and functional outcomes than the optimal rate control strategy (** node ablation and biventricular pacing). A hundred per cent of patients in the ** node ablation and pacing arm had atrial fibrillation at 3 and 6 months—an unexpected finding.
房颤节律控制随访调查（AFFIRM）研究是一直以来争论话题的界标。它表明速率的控制比节律的控制更为获益。然而，其后对这些数据的分析表明，节律的控制和恢复窦律可提高存活率。在此实验中，肺静脉隔离（有争议的控制节律的方式）成功控制速率，其形态学和功能方面的结果均优于最佳速率控制方式（房室结消融加双室起搏）。令人意外的是，所有房室结消融加双室起搏的患者在随后3-6个随访中均出现房颤。
Although this study is limited by the short follow-up data and the fact that the procedures were all performed in very experienced centres, it nonetheless provides strong support for PVI in centres with the appropriate experience.
此研究虽受随访时间的限制，但手术均在非常有经验的医院操作，仍对具备一定经验的医院开展肺静脉隔离术提供强有力的支持。

2009-03-22 14:30

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在低射血分数的充血性心衰患者中使用肺静脉隔离有效
尽管一些研究包括少数低射血分数的患者，房室结消融仍习惯上用于治疗有症状的房颤患者控制节律。近来，双室起搏表现出比房室结消融后的右室起搏更佳的效果。
肺静脉窦隔离和双室起搏的房室结消融术在治疗房颤合并充血性心力衰竭的患者时的比较实验，目的是比较肺静脉隔离与房室结消融加双室起搏在射血分数<40%、有症状的房颤、纽约心功能分级II–III级的心衰患者中的治疗效果。这是个前瞻、多中心随机对照试验。主要终点事件是射血分数、6分钟步行实验、明尼苏达生活质量分数的复合。以术后2-6个月患者携带的环状事件监测器记录随访，其可记录患者每一症状，即使没有任何症状的情况下，每周也至少记录2-3次。
总计41为接受肺静脉隔离和40位接受房室结消融加双室起搏的患者。复合主要终点事件在接受肺静脉隔离的患者表现的更佳，其6个月的生活质量分数提高(p<0.001)、6分钟步行试验延长(与房室结消融加双室起搏比较340 m比297 m, p<0.001)、射血分数增加(35% 比28%, p<0.001)。在肺静脉隔离组，88%的患者服用了抗心律失常药物，没有服用抗心律失常药的患者中的71%，在其后6个月没有发生房颤。在肺静脉隔离治疗组中，2人出现肺静脉狭窄，1人出现心包积液，1人出现肺水肿。在房室结消融加双室起搏组，1人导联置换，1人气胸。
房颤节律控制随访调查（AFFIRM）研究是一直以来争论话题的界标。它表明速率的控制比节律的控制更为获益。然而，其后对这些数据的分析表明，节律的控制和恢复窦律可提高存活率。在此实验中，肺静脉隔离（有争议的控制节律的方式）成功控制速率，其形态学和功能方面的结果均优于最佳速率控制方式（房室结消融加双室起搏）。令人意外的是，所有房室结消融加双室起搏的患者在随后3-6个随访中均出现房颤。
此研究虽受随访时间的限制，但手术均在非常有经验的医院操作，仍对具备一定经验的医院开展肺静脉隔离术提供强有力的支持。

2009-03-22 14:30

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