2025 年第 10 期 第 20 卷

高龄心房颤动患者导管消融与心血管预后的关系

Relationship between catheter ablation of atrial fibrillation and cardiovascular prognosis in elderly patients

作者：李思彤赵媚琪李明宵何柳周宁桑才华马长生

英文作者：Li Sitong Zhao Meiqi Li Mingxiao He Liu Zhou Ning Sang Caihua Ma Changsheng

单位：首都医科大学附属北京安贞医院心血管内科，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心房颤动；导管消融；高龄；心血管预后

英文关键词：

• 摘要：

• 目的 评估导管消融在高龄心房颤动患者中的疗效。方法 选取中国心房颤动注册研究2011年8月至2022年12月记录的年龄≥75岁患者。根据基线是否接受导管消融分为消融组与非消融组。主要终点为心血管死亡与心血管住院的复合终点，次要终点包括心血管死亡、心血管住院、栓塞事件及心房颤动复发。采用Kaplan-Meier法绘制生存曲线。采用多因素Cox回归及重叠加权分析评估导管消融与终点的关系。结果 共纳入2 912例患者，消融组976例、非消融组1 936例。生存曲线分析显示，消融组发生心血管死亡或心血管住院的风险低于非消融组（风险比=0.68，95%置信区间：0.60~0.76，Log-rank P<0.001）。随访35.2（14.7，64.5）个月，1 418例患者出现了心血管死亡或心血管住院，发病率为13.7/100例年，其中消融组发病率为10.4/100例年、非消融组为15.2/100例年。调整混杂因素后，导管消融与心血管死亡或心血管住院的复合风险降低显著相关（风险比=0.82，95%置信区间:0.72~0.93,P=0.003），重叠加权分析结果相似。此外，导管消融与心血管死亡（风险比=0.38，重叠加权风险比=0.35，均P<0.001）及心房颤动（风险比=0.30，重叠加权风险比=0.28，均P<0.001）复发风险显著降低有关。结论 在高龄心房颤动患者中，导管消融与较低的心血管死亡或心血管住院和较低的心房颤动复发风险相关。

• Objective To evaluate the efficacy of catheter ablation for atrial fibrillation in elderly patients. Methods Patients aged 75 years or older were enrolled from the China Atrial Fibrillation Registry Study from August 2011 to December 2022. Patients were divided into ablation group and non-ablation group according to whether they received ablation at baseline. The primary endpoint was the composite endpoint of cardiovascular death and cardiovascular hospitalization. The secondary endpoints included cardiovascular death, cardiovascular hospitalization, embolic events and recurrence of atrial fibrillation. The Kaplan-Meier method was used to draw the survival curve. Multivariate Cox regression and overlapping weighted analysis were used to evaluate the relationship between ablation and endpoint. Results A total of 2 912 patients were enrolled, including 976 in the ablation group and 1 936 in the non-ablation group. Survival curve analysis showed that the risk of cardiovascular death or cardiovascular hospitalization in the ablation group was lower than that in the non-ablation group (hazard ratio=0.68, 95% confidence interval: 0.60-0.76, Log-rank P<0.001). During the follow-up of 35.2(14.7,64.5)months, 1 418 patients had cardiovascular death or cardiovascular hospitalization, and the incidence was 13.7/100 patient-years. The incidence was 10.4/100 patient-years in the ablation group and 15.2/100 patient-years in the non-ablation group. Catheter ablation was associated with a significantly lower composite risk of cardiovascular death or cardiovascular hospitalization after adjustment for confounders (hazard ratio=0.82, 95% confidence interval: 0.72-0.93, P=0.003), with similar results in overlap-weighted analyses. In addition, catheter ablation was significantly associated with reduced risks of cardiovascular death (hazard ratio=0.38, overlap-weighted hazard ratio=0.35, both P<0.001) and recurrence of atrial fibrillation (hazard ratio=0.30, overlap-weighted hazard ratio=0.28, both P<0.001). Conclusion In older patients with atrial fibrillation, catheter ablation is associated with a lower risk of cardiovascular death or cardiovascular hospitalization and a lower risk of atrial fibrillation recurrence.