背景:电风暴(ES)是一种威胁生命的疾病,与大量早期和亚急性死亡率相关。导管消融(CA)是一种公认的ES疗法。然而,关于CA对ES患者短期和中期生存率影响的数据尚不清楚.
目的:这项多中心研究旨在调查ES的CA对生存结局的影响,同时考虑与治疗选择相关的关键患者特征。
方法:对4个三级中心的780例连续住院ES患者进行了倾向评分匹配(PSM)分析。根据与使用CA或单独药物治疗相关的主要特征进行PSM(1:1),产生2组288例患者。
结果:PSM后,接受CA的患者(n=288)和仅接受药物治疗的患者(n=288)在主要人口统计学特征上没有任何显着差异。ES介绍,和管理。与单纯的药物治疗相比,CA与1年时ES复发率显著降低相关(5%vs26%;P<0.001)。同样,CA与出院后较高的1年生存率(91%vs81%;P<0.001)和3年生存率(78%vs71%;P=0.017)相关。在亚组分析中,70岁以上患者的消融治疗效果保持一致(HR:0.39;95%CI:0.24-0.66),在LVEF<35%的患者中具有实质性疗效(HR:0.39;95%CI:0.27-0.59)。
结论:在倾向匹配分析中,这项大型研究表明,与药物治疗相比,基于CA的ES患者管理与死亡率降低相关。尤其是低射血分数的患者。
BACKGROUND: Electrical storm (ES) is a life-threatening condition, associated with substantial early and subacute mortality. Catheter ablation (CA) is a well-established therapy for ES. However, data regarding the impact of CA on the short-term and midterm survival of patients admitted for ES remain unclear.
OBJECTIVE: This multicenter study aimed to investigate the impact of CA of ES on survival outcomes, while accounting for key patient characteristics associated with treatment selection.
METHODS: A propensity score-matching (PSM) analysis was performed on 780 consecutive patients admitted for ES in 4 tertiary centers. PSM (1:1) based on the main characteristics associated with the use of CA or medical therapy alone was performed, resulting in 2 groups of 288 patients.
RESULTS: After PSM, patients who underwent CA (n = 288) and those treated with medical therapy alone (n = 288) did not present any significant differences in the main demographic characteristics, ES presentation, and management. Compared with medical therapy alone, CA was associated with a significantly lower rate of ES recurrence at 1 year (5% vs 26%; P < 0.001). Similarly, CA was associated with a higher 1-year (91% vs 81%; P < 0.001) and 3-year (78% vs 71%; P = 0.017) survival after discharge. In subgroup analyses, effect of ablation therapy remained consistent in patients older than 70 years of age (HR: 0.39; 95% CI: 0.24-0.66), with substantial efficacy in patients with a LVEF <35% (HR: 0.39; 95% CI: 0.27-0.59).
CONCLUSIONS: In propensity-matched analyses, this large study shows that CA-based management of patients admitted for ES is associated with a reduction in mortality compared with medical treatment, particularly in patients with a low ejection fraction.