Abstract：
BACKGROUND: Rheumatic heart disease with persistent atrial fibrillation (RHD-AF) is associated with increased morbidity. However, there is no standardized approach for the maintenance of sinus rhythm (SR) in them. We aimed to determine the utility of a stepwise approach to achieve SR in RHD-AF.
METHODS: Consecutive patients with RHD-AF from July 2021 to August 2023 formed the study cohort. The stepwise approach included pharmacological rhythm control and/or electrical cardioversion (Central illustration). In patients with recurrence, additional options included AF ablation or pace and ablate strategy with conduction system pacing or biventricular pacing. Clinical improvement, NT-proBNP, 6-Minute Walk Test (6MWT), heart failure (HF) hospitalizations, and thromboembolic complications were documented during follow-up.
RESULTS: Eighty-three patients with RHD-AF (mean age 56.13 ± 9.51 years, women 72.28%) were included. Utilizing this approach, 43 (51.81%) achieved and maintained SR during the study period of 11.04 ± 7.14 months. These patients had improved functional class, lower NT-proBNP, better distance covered for 6MWT, and reduced HF hospitalizations. The duration of AF was shorter in patients who achieved SR, compared to those who remained in AF (3.15 ± 1.29 vs 6.93 ± 5.23, p = 0.041). Thirty-five percent (29) maintained SR after a single cardioversion over the study period. Only one underwent AF ablation. Of the 24 who underwent pace and ablate strategy, atrial lead was implanted in 22 (hybrid approach), and 50% of these achieved and maintained SR. Among these 24, none had HF hospitalizations, but patients who maintained SR had further improvement in clinical and functional parameters.
CONCLUSIONS: RHD-AF patients who could achieve SR with a stepwise approach, had better clinical outcomes and lower HF hospitalizations.
METHODS: Consecutive patients with RHD-AF from July 2021 to August 2023 formed the study cohort. The stepwise approach included pharmacological rhythm control and/or electrical cardioversion (Central illustration). In patients with recurrence, additional options included AF ablation or pace and ablate strategy with conduction system pacing or biventricular pacing. Clinical improvement, NT-proBNP, 6-Minute Walk Test (6MWT), heart failure (HF) hospitalizations, and thromboembolic complications were documented during follow-up.
RESULTS: Eighty-three patients with RHD-AF (mean age 56.13 ± 9.51 years, women 72.28%) were included. Utilizing this approach, 43 (51.81%) achieved and maintained SR during the study period of 11.04 ± 7.14 months. These patients had improved functional class, lower NT-proBNP, better distance covered for 6MWT, and reduced HF hospitalizations. The duration of AF was shorter in patients who achieved SR, compared to those who remained in AF (3.15 ± 1.29 vs 6.93 ± 5.23, p = 0.041). Thirty-five percent (29) maintained SR after a single cardioversion over the study period. Only one underwent AF ablation. Of the 24 who underwent pace and ablate strategy, atrial lead was implanted in 22 (hybrid approach), and 50% of these achieved and maintained SR. Among these 24, none had HF hospitalizations, but patients who maintained SR had further improvement in clinical and functional parameters.
CONCLUSIONS: RHD-AF patients who could achieve SR with a stepwise approach, had better clinical outcomes and lower HF hospitalizations.
摘要：
背景：风湿性心脏病伴持续性心房颤动（RHD-AF）与发病率增加相关。然而,维持窦性心律（SR）没有标准化的方法。我们旨在确定逐步方法在RHD-AF中实现SR的实用性。
方法：2021年7月至2023年8月连续RHD-AF患者组成研究队列。逐步方法包括药理节律控制和/或电复律（中央图）。在复发的患者中，其他选择包括AF消融或传导系统起搏或双心室起搏的起搏和消融策略.临床改善,NT-proBNP,6分钟步行测试(6MWT),心力衰竭（HF）住院，随访期间记录血栓栓塞并发症.
结果：83例RHD-AF患者（平均年龄56.13±9.51岁，女性72.28%）被包括在内。利用这种方法，43（51.81%）在11.04±7.14个月的研究期间达到并维持SR。这些患者的功能类别有所改善，较低的NT-proBNP，更好的距离覆盖6MWT，和减少HF住院。达到SR的患者房颤持续时间较短，与房颤患者相比（3.15±1.29vs6.93±5.23，p=0.041）。在研究期间，有35％（29）的人在一次心脏复律后保持SR。只有1人接受了AF消融。在接受步伐和消融策略的24人中，在22处植入心房导联（混合方法），其中50%实现并保持了SR。在这24人中，没有人住院，但保持SR的患者在临床和功能参数方面有进一步改善.
结论：RHD-AF患者可以通过逐步方法达到SR，具有更好的临床结局和更低的HF住院率.
方法：2021年7月至2023年8月连续RHD-AF患者组成研究队列。逐步方法包括药理节律控制和/或电复律（中央图）。在复发的患者中，其他选择包括AF消融或传导系统起搏或双心室起搏的起搏和消融策略.临床改善,NT-proBNP,6分钟步行测试(6MWT),心力衰竭（HF）住院，随访期间记录血栓栓塞并发症.
结果：83例RHD-AF患者（平均年龄56.13±9.51岁，女性72.28%）被包括在内。利用这种方法，43（51.81%）在11.04±7.14个月的研究期间达到并维持SR。这些患者的功能类别有所改善，较低的NT-proBNP，更好的距离覆盖6MWT，和减少HF住院。达到SR的患者房颤持续时间较短，与房颤患者相比（3.15±1.29vs6.93±5.23，p=0.041）。在研究期间，有35％（29）的人在一次心脏复律后保持SR。只有1人接受了AF消融。在接受步伐和消融策略的24人中，在22处植入心房导联（混合方法），其中50%实现并保持了SR。在这24人中，没有人住院，但保持SR的患者在临床和功能参数方面有进一步改善.
结论：RHD-AF患者可以通过逐步方法达到SR，具有更好的临床结局和更低的HF住院率.
