导管切除在心脏衰竭的末期阶段与心房动
Christian Sohns1, Henrik Fox1, Nassir F Marrouche1
1From the Clinics for Electrophysiology (C.S., L.B., T.F., M.E.H., M.M., V.S., P.S.), Thoracic and Cardiovascular Surgery (H.F., A.C.-J., R.S., J.G.), and General and Interventional Cardiology-Angiology (V.R.) and the Center for Interdisciplinary Management of Advanced Heart Failure (H.F., A.C.J., R.S., J.G.), Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, the Department of Cardiology, Angiology, and Intensive Care Medicine, Charité Campus Mitte, German Heart Center of Charité-University Medicine Berlin (G.H.), and the Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin (F.K.), Berlin, the Department of Electrophysiology, Heart Center Leipzig, Leipzig (N.D.), and the Department of Cardiology and Angiology, University of Giessen and Kerckhoff Heart Center, Bad Nauheim (S.S.) - all in Germany; the Cardiology Department, Tulane University School of Medicine, New Orleans (N.F.M.); and the Department of Cardiology and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht (H.J.G.M.C.), and the Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.G.P.T.) - both in the Netherlands.
与药物治疗相结合的导管切除可显著减少与单独治疗相比,心房动和终期心力衰竭患者的不良事件.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭管理的管理
背景情况:
- 在症状性心房动 (AF) 和末期心力衰竭 (EHF) 的患者中,导管切除的疗效尚不清楚.
- 患有EHF和AF的患者经常面临有限的治疗选择和不良预后.
研究的目的:
- 调查导管切除与指导指导医学疗法 (GDMT) 结合,与单独GDMT对AF和EHF患者主要不良心血管结局的影响.
- 评估导管切除作为高风险患者群体中治疗策略的安全性和有效性.
主要方法:
- 德国的一项单中心,开放性试验随机选择了194名患有症状的AF和EHF的患者,转诊进行心脏移植评估.
- 患者被分配到导管切除加GDMT或单独使用GDMT.
- 主要终点是所有原因死亡,左心室辅助器件 (LVAD) 植入或紧急心脏移植的复合.
主要成果:
- 该试验在1年后被提前停止,以确保有效性. 导管切除在切除组中进行了84%.
- 主要终点事件发生在8%的废除组与30%的医疗治疗组 (危险比,0.24;P<0.001).
- 在废除组中,所有原因的死亡率明显较低 (6%对20%). 与程序相关的并发症是罕见的,并且在不同组之间可比.
结论:
- 与单独使用GDMT相比,在患有AF和EHF的患者中,导管切除加GDMT显著降低了死亡,LVAD植入或紧急心脏移植的风险.
- 导管切除是一种安全有效的治疗选择,用于选择患有AF和末期心力衰竭的患者.
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