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随机研究比较射频废除与PVAC黄金系统与抗心律不良药在老年患者有症状心房的随机研究
Luiz Claudio Berhmann Martins1, Cristiano F Pisani1, Fabio K Dorfman1
1Unidade de Arritmia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Arquivos brasileiros de cardiologia
|August 7, 2024
概括
导管切除 (CA) 和抗心律失常药物 (AA) 都改善了老年患者的生活质量. 然而,CA的无复发率高于AA治疗,尽管在统计学上并不显著.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 老年医学 老年医学
背景情况:
- 现有有限的随机研究比较了导管切除 (CA) 与抗失律药物 (AA) 以维持老年患者的鼻节律和心房动 (AF).
- 患有至少一个AA耐火性帕洛西斯马性AF的老年患者,并且没有结构性心脏病,代表了对有效节律控制策略的未满足需求的人群.
研究的目的:
- 为了比较肺静脉 (PV) 隔离的临床结果,使用第二代PVAC金色导管与老年患者的AA治疗相比.
- 评估CA和AA治疗组之间的AF无复发率,进展到持久的AF,生活质量 (QOLF) 和并发症率.
主要方法:
- 一项随机研究涉及60名年龄在65岁或以上的患者,他们患有偏激性AF.
- 患者被随机分为两组:第一组接受CA (PV隔离),第二组接受AA药物.
- 主要结局是AF复发率在一年的随访后,二次结局包括AF进展,QOLF和并发症.
主要成果:
- 在平均719天的随访后,AF无复发率在CA组为80%,而在AA组为65% (p=0.119).
- 持久性AF免费率为CA的83.4%和AA的67.7% (p=0.073).
- 两组均显示QOLF有所改善 (p<0.001),两组之间没有显著差异. 值得注意的是,25%的CA患者在MRI上表现出脑栓塞迹象,没有临床影响.
结论:
- 导管切除和抗心律失常药物策略都有效地改善了老年患者的生命质量.
- 虽然CA显示出更好的无复发率的趋势,但与AA治疗相比,临床结果没有统计学上显著的差异.
- 需要进一步研究先进技术,重点关注安全性,以充分阐明CA在老年人群中的好处.
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