医学
射血分数
心脏病学
射频消融术
内科学
心力衰竭
窦性心律
心房颤动
利钠肽
临床终点
随机对照试验
烧蚀
作者
Michael R. MacDonald,Derek T. Connelly,Nathaniel M. Hawkins,Tracey Steedman,John Payne,M. Shaw,MA Denvir,Sai Bhagra,A.D. Small,William Martin,John J.V. McMurray,Mark C. Petrie
出处
期刊:Heart
[BMJ]
日期:2010-11-04
卷期号:97 (9): 740-747
被引量:317
标识
DOI:10.1136/hrt.2010.207340
摘要
To determine whether or not radiofrequency ablation (RFA) for persistent atrial fibrillation in patients with advanced heart failure leads to improvements in cardiac function.Patients were recruited from heart failure outpatient clinics in Scotland.Patients with advanced heart failure and severe left ventricular dysfunction were randomised to RFA (rhythm control) or continued medical treatment (rate control). Patients were followed up for a minimum of 6 months.Change in left ventricular ejection fraction (LVEF) measured by cardiovascular MRI.22 patients were randomised to RFA and 19 to medical treatment. In the RFA group, 50% of patients were in sinus rhythm at the end of the study (compared with none in the medical treatment group). The increase in cardiovascular magnetic resonance (CMR) LVEF in the RFA group was 4.5±11.1% compared with 2.8±6.7% in the medical treatment group (p=0.6). The RFA group had a greater increase in radionuclide LVEF (a prespecified secondary end point) than patients in the medical treatment group (+8.2±12.0% vs +1.4±5.9%; p=0.032). RFA did not improve N-terminal pro-B-type natriuretic peptide, 6 min walk distance or quality of life. The rate of serious complications related to RFA was 15%.RFA resulted in long-term restoration of sinus rhythm in only 50% of patients. RFA did not improve CMR LVEF compared with a strategy of rate control. RFA did improve radionuclide LVEF but did not improve other secondary outcomes and was associated with a significant rate of serious complications.
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