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        射血分?jǐn)?shù)保留的心力衰竭合并心房顫動(dòng)的臨床特點(diǎn)分析

        2025-02-28 00:00:00王單鳳劉鵬馮玉寶
        中國(guó)現(xiàn)代醫(yī)生 2025年3期
        關(guān)鍵詞:心房顫動(dòng)

        [摘要] 心力衰竭是心房顫動(dòng)的易患因素,而心房顫動(dòng)可誘導(dǎo)并加重心力衰竭,二者相互促進(jìn),進(jìn)而形成惡性循環(huán)。隨著對(duì)心力衰竭研究的不斷深入,射血分?jǐn)?shù)保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)也愈加受到學(xué)者關(guān)注。HFpEF常合并心房顫動(dòng),心房顫動(dòng)也是HFpEF中常見(jiàn)的房性心律失常。HFpEF與心房顫動(dòng)在發(fā)病機(jī)制上相互重疊,且可相互促發(fā)。本文對(duì)HFpEF合并心房顫動(dòng)的流行病學(xué)特征、危險(xiǎn)因素、病理生理機(jī)制、臨床評(píng)估方法、患者預(yù)后及應(yīng)用導(dǎo)管消融術(shù)治療該疾病的臨床效果進(jìn)行綜述。

        [關(guān)鍵詞] 射血分?jǐn)?shù)保留的心力衰竭;心房顫動(dòng);導(dǎo)管消融術(shù)

        [中圖分類號(hào)] R541.6" """"[文獻(xiàn)標(biāo)識(shí)碼] A """""[DOI] 10.3969/j.issn.1673-9701.2025.03.027

        近年來(lái),射血分?jǐn)?shù)保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)的發(fā)病率呈上升趨勢(shì),約50%的心力衰竭住院患者可發(fā)生HFpEF[1]。心房顫動(dòng)是臨床中常見(jiàn)的心動(dòng)過(guò)速。研究表明心房顫動(dòng)終生患病風(fēng)險(xiǎn)高達(dá)30%[2]。HFpEF和心房顫動(dòng)在臨床中常合并存在,二者具有共同的發(fā)病危險(xiǎn)因素,具有相互促發(fā)的作用機(jī)制。這種現(xiàn)象可被稱為“HFpEF生心房顫動(dòng)”“心房顫動(dòng)生HFpEF”[3]。HFpEF的診斷依據(jù)主要有心力衰竭的臨床癥狀、體征及左心室射血分?jǐn)?shù)超過(guò)50%[4]。但包括心房顫動(dòng)在內(nèi)的其他多種疾病也表現(xiàn)為乏力、氣短、心悸等類似心力衰竭的癥狀。同時(shí),應(yīng)用超聲心動(dòng)檢查測(cè)定左心室射血分?jǐn)?shù)受操作者主觀因素的影響,進(jìn)而造成HFpEF診斷的復(fù)雜性。

        1" HFpEF合并心房顫動(dòng)的流行病學(xué)特征

        1.1" HFpEF患者心房顫動(dòng)的發(fā)病率和患病率

        流行病學(xué)研究證實(shí),心力衰竭是心房顫動(dòng)發(fā)病的潛在危險(xiǎn)因素。研究顯示,在納入939例無(wú)心房顫動(dòng)的HFpEF患者中,32%的患者發(fā)生心房顫動(dòng)[5]。在一項(xiàng)41 446例心力衰竭患者的研究中,心房顫動(dòng)的患病率為65%;與射血分?jǐn)?shù)中間值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)和射血分?jǐn)?shù)降低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)比較,HFpEF患者心房顫動(dòng)的患病率更高[6]。

        1.2 "心房顫動(dòng)患者HFpEF的發(fā)病率和患病率

        目前,雖然已有較多針對(duì)心房顫動(dòng)患者發(fā)生心力衰竭風(fēng)險(xiǎn)的相關(guān)研究,但關(guān)于HFpEF發(fā)生風(fēng)險(xiǎn)的研究則較少。研究發(fā)現(xiàn)有心房顫動(dòng)病史患者的HFpEF發(fā)病率顯著高于無(wú)心房顫動(dòng)病史患者,其風(fēng)險(xiǎn)比(hazard ratio,HR)為4.8[7]。心房顫動(dòng)是HFpEF發(fā)生的獨(dú)立危險(xiǎn)因素,且心房顫動(dòng)對(duì)HFpEF的預(yù)測(cè)價(jià)值高于其對(duì)HFrEF的預(yù)測(cè)[8]。心房顫動(dòng)患者HFpEF患病率的研究主要有心房顫動(dòng)節(jié)律控制的隨訪研究、全球性橫斷面觀察注冊(cè)研究RealiseAF和歐洲觀察研究計(jì)劃心房顫動(dòng)試點(diǎn)調(diào)查,三項(xiàng)研究顯示其患病率分別為8%、18%和17%[9-11]。

        2" HFpEF和心房顫動(dòng)的危險(xiǎn)因素

        心房顫動(dòng)是增齡性疾病。隨著年齡的增長(zhǎng),心房顫動(dòng)的發(fā)病率也隨之增加。同樣,年齡因素在HFpEF的病理生理過(guò)程中有重要作用,機(jī)體可表現(xiàn)出與年齡相關(guān)的左心室舒張功能不全。肥胖、高血壓、睡眠呼吸暫停等與年齡相關(guān)的合并癥也是上述兩種疾病的共同危險(xiǎn)因素[12-13]。研究表明高強(qiáng)度耐力運(yùn)動(dòng)可促進(jìn)心房顫動(dòng)的發(fā)生。但近期研究卻發(fā)現(xiàn)HFpEF患者進(jìn)行高強(qiáng)度的體育鍛煉可降低心房顫動(dòng)的發(fā)生風(fēng)險(xiǎn)[14-15]

        3" HFpEF和心房顫動(dòng)的相互促進(jìn)作用

        在臨床上,HFpEF與心房顫動(dòng)常合并存在,二者具有共同的病理生理學(xué)機(jī)制。心房顫動(dòng)和心力衰竭患者均可表現(xiàn)為心房肌細(xì)胞內(nèi)線粒體結(jié)構(gòu)和功能破壞、能量失衡及氧化應(yīng)激。HFpEF和心房顫動(dòng)在發(fā)病機(jī)制上是相互促進(jìn)的[16]。

        3.1" HFpEF促進(jìn)心房顫動(dòng)的發(fā)生

        HFpEF可引起左心房結(jié)構(gòu)、功能、電學(xué)重構(gòu),這是HFpEF促進(jìn)心房顫動(dòng)發(fā)生的主要病理生理學(xué)機(jī)制。HFpEF可引起左心房增大,其應(yīng)力和纖維化程度增加,為心房顫動(dòng)的發(fā)生提供可能[17]。在心力衰竭患者中,心房肌細(xì)胞中的L-型鈣通道電流、瞬時(shí)外向鉀電流、延遲整流鉀電流減少,而瞬時(shí)內(nèi)向鈉鈣交換電流增加。這些變化可導(dǎo)致動(dòng)作電位時(shí)程發(fā)生改變,增加觸發(fā)活動(dòng),進(jìn)而引發(fā)包括心房顫動(dòng)在內(nèi)的多種心律失常疾病[18]。

        3.2" 心房顫動(dòng)促進(jìn)HFpEF的發(fā)生

        心房的結(jié)構(gòu)、功能及電學(xué)重構(gòu)可促進(jìn)心房顫動(dòng)的發(fā)生,心房顫動(dòng)的發(fā)生與持續(xù)亦可進(jìn)一步促進(jìn)心房的擴(kuò)大和纖維化,此現(xiàn)象被稱為“心房顫動(dòng)生心房顫動(dòng)”。心房顫動(dòng)導(dǎo)致的房室不同步、快速心律失常性心肌病、心房收縮和舒張功能破壞及二尖瓣和三尖瓣反流可使心房壓力和負(fù)荷增加,損害心室功能[19]。研究表明心房顫動(dòng)可促進(jìn)心室肌纖維化,進(jìn)而導(dǎo)致心室舒張功能障礙,并引發(fā)HFpEF[20]。

        4" HFpEF合并心房顫動(dòng)的臨床評(píng)估

        HFpEF與心房顫動(dòng)常共存。據(jù)報(bào)道,HFrEF患者心房顫動(dòng)的患病率為36.7%~44.9%,HFpEF患者心房顫動(dòng)的患病率為40%~50%[21]。研究證據(jù)表明HFpEF與心房顫動(dòng)的關(guān)系更為密切。研究發(fā)現(xiàn),與無(wú)心房顫動(dòng)的HFpEF患者相比,心房顫動(dòng)可顯著增加HFpEF患者的再住院率及死亡率[22]。與其他類型心力衰竭相比,HFpEF患者心房顫動(dòng)發(fā)病率更高且預(yù)后更差[6]。針對(duì)HFmrEF和HFpEF的注冊(cè)研究發(fā)現(xiàn),在HFpEF住院患者中,心房顫動(dòng)發(fā)病率顯著增加;在79 895例出院后患者中,心房顫動(dòng)與12個(gè)月時(shí)更高的死亡率和全因再住院風(fēng)險(xiǎn)獨(dú)立相關(guān);與HFmrEF相比,心房顫動(dòng)合并HFpEF的死亡率更高[23]。綜上,心房顫動(dòng)可進(jìn)一步加重HFpEF的疾病進(jìn)展。

        在反映活動(dòng)耐力評(píng)分中,合并心房顫動(dòng)HFpEF患者的堪薩斯城心肌病調(diào)查問(wèn)卷評(píng)分更高,但心房顫動(dòng)對(duì)HFpEF患者6min步行測(cè)試結(jié)果并無(wú)顯著影響[24]。這可能是因?yàn)镠FpEF患者的心力衰竭癥狀較輕,6min步行測(cè)試反映心力衰竭的敏感度較低,無(wú)法準(zhǔn)確提示病情變化和差異。心房顫動(dòng)可顯著提高HFpEF患者的N末端B型利鈉肽前體(N-terminal pro-B type natriuretic peptide,NT-proBNP)水平[24-25]。有研究對(duì)比心房顫動(dòng)對(duì)HFpEF和HFrEF患者的影響,明確HFrEF合并心房顫動(dòng)患者較無(wú)心房顫動(dòng)患者的NT-proBNP、促甲狀腺激素、血肌酐水平顯著升高;HFpEF合并心房顫動(dòng)患者較無(wú)心房顫動(dòng)患者的NT-proBNP水平升高,但促甲狀腺素和血肌酐水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義[25]。結(jié)果提示心力衰竭嚴(yán)重程度在患者對(duì)心房顫動(dòng)的耐受程度當(dāng)中也可能表現(xiàn)出差異,射血分?jǐn)?shù)較低患者發(fā)生心房顫動(dòng)時(shí),表現(xiàn)出更多的生化指標(biāo)異常,其具體病理生理學(xué)機(jī)制有待進(jìn)一步明確。心房顫動(dòng)的發(fā)生可引起患者NT- proBNP、堪薩斯城心肌病調(diào)查問(wèn)卷評(píng)分顯著升高。綜上,心房顫動(dòng)可進(jìn)一步加重HFpEF患者的心力衰竭癥狀,降低患者的活動(dòng)耐量和生活質(zhì)量。

        5" HFpEF合并心房顫動(dòng)的預(yù)后

        在涵蓋歐洲多個(gè)國(guó)家的大型臨床研究中發(fā)現(xiàn),HFpEF合并心房顫動(dòng)患者長(zhǎng)期心血管結(jié)局更差,經(jīng)過(guò)多變量調(diào)整后提示心房顫動(dòng)是HFpEF患者引起心力衰竭住院及全因死亡的獨(dú)立危險(xiǎn)因素[26-27]。在血栓栓塞事件方面,有研究對(duì)比HFpEF合并心房顫動(dòng)及 HFrEF合并心房顫動(dòng)患者的發(fā)生率,二者比較差異并無(wú)統(tǒng)計(jì)學(xué)意義[28]。一項(xiàng)包含14項(xiàng)臨床研究的Meta分析提示,心房顫動(dòng)可使HFpEF患者的全因死亡風(fēng)險(xiǎn)增加11%[29]。另一項(xiàng)包含10項(xiàng)研究的Meta分析提示,HFrEF合并心房顫動(dòng)的全因死亡率顯著高于HFpEF合并心房顫動(dòng)患者,但心力衰竭患者的住院率及腦卒中發(fā)病率相當(dāng),提示在心房顫動(dòng)患者中,左心室功能的減退可導(dǎo)致射血分?jǐn)?shù)減低,預(yù)示患者預(yù)后不佳[30]。

        6" HFpEF合并心房顫動(dòng)的導(dǎo)管消融術(shù)治療

        HFpEF合并心房顫動(dòng)患者如能維持竇性心律,可顯著降低心血管死亡風(fēng)險(xiǎn)和心力衰竭再入院風(fēng)險(xiǎn)[31]。射頻消融術(shù)作為治療心房顫動(dòng)的有效手段,可成為HFpEF合并心房顫動(dòng)患者治療選擇之一。目前,有關(guān)HFpEF合并心房顫動(dòng)導(dǎo)管消融術(shù)治療的相關(guān)研究仍較為缺乏。

        6.1" 導(dǎo)管消融術(shù)手術(shù)策略

        當(dāng)前心房顫動(dòng)射頻消融策略包括基于解剖學(xué)的環(huán)肺靜脈電隔離、線性消融和基于心房電壓的基質(zhì)消融、復(fù)雜碎裂電位消融、房室結(jié)消融、Marshall靜脈無(wú)水乙醇化學(xué)消融及脈沖電場(chǎng)消融等[32-34]。近期有研究針對(duì)心房顫動(dòng)合并不同類型心力衰竭患者的導(dǎo)管消融策略進(jìn)行對(duì)比,研究共納入728例心力衰竭合并心房顫動(dòng)患者,其中有83.4%的HFpEF患者、78.4%的HFmrEF患者及48.9%的HFrEF患者的手術(shù)策略是環(huán)肺靜脈電隔離,其余患者的手術(shù)策略是房室結(jié)消融術(shù)治療[35]。研究結(jié)果提示,環(huán)肺靜脈電隔離依然是心房顫動(dòng)合并HFpEF患者導(dǎo)管消融術(shù)治療的基石。但該研究并不具有全球代表性,尚需來(lái)自多個(gè)國(guó)家和地區(qū)的心臟中心數(shù)據(jù)支持。

        6.2" 導(dǎo)管消融術(shù)后的再入院率

        如前所述,心房顫動(dòng)的發(fā)生可導(dǎo)致HFpEF患者的全因死亡和心力衰竭住院率升高。在對(duì)合并心房顫動(dòng)的HFpEF患者行導(dǎo)管消融術(shù)后,短于1年隨訪期患者的心力衰竭再入院風(fēng)險(xiǎn)并未顯著降低,但2年隨訪期患者的心力衰竭再入院風(fēng)險(xiǎn)顯著降低[36]。研究發(fā)現(xiàn)接受導(dǎo)管消融術(shù)治療的HFpEF合并心房顫動(dòng)患者較接受單純抗心律失常藥物治療的全因再入院率低[36]。雖然該研究結(jié)果傾向于提示導(dǎo)管消融術(shù)在降低患者全因再入院率中的優(yōu)勢(shì),但研究并未排除抗心律失常藥物的不良反應(yīng)對(duì)研究結(jié)果的影響。在HFpEF患者中,治療心房顫動(dòng)的導(dǎo)管消融術(shù)可顯著降低患者長(zhǎng)期的心力衰竭再入院風(fēng)險(xiǎn)。

        6.3" 導(dǎo)管消融術(shù)后心功能評(píng)估

        有學(xué)者在針對(duì)HFpEF合并心房顫動(dòng)患者的研究中發(fā)現(xiàn),患者在接受心房顫動(dòng)導(dǎo)管消融術(shù)后,可維持竇性心律患者的左心室收縮指數(shù)較心房顫動(dòng)節(jié)律患者顯著改善,同時(shí)反映舒張功能的E/E'及等容舒張期平均左室應(yīng)變峰值、舒張?jiān)缙谄骄笫覒?yīng)變峰值也得到顯著改善。多因素Cox回歸分析結(jié)果顯示,心房顫動(dòng)類型(長(zhǎng)程持續(xù)性心房顫動(dòng)除外)和無(wú)高血壓與維持竇性心律獨(dú)立相關(guān)[37]。因此,在導(dǎo)管消融術(shù)后,左心室收縮和舒張功能的改善主要取決于是否可維持竇性心律。因超聲心動(dòng)圖在診斷舒張功能不全方面具有局限性。近期有學(xué)者利用右心導(dǎo)管診斷HFpEF,研究中將靜息肺毛細(xì)血管楔壓(resting pulmonary capillary wedge pressure,PCWP)≥15mmHg(1mmHg=0.133kPa)及運(yùn)動(dòng)峰值PCWP≥25mmHg定義為舒張功能不全,研究結(jié)果提示HFpEF患者在接受導(dǎo)管消融術(shù)治療后,維持竇性心律患者的運(yùn)動(dòng)峰值PCWP有效降低,舒張功能得以顯著改善[38]。

        7" 小結(jié)

        由于HFpEF和心房顫動(dòng)在發(fā)病機(jī)制方面的相互重疊與相互促發(fā),在臨床中同時(shí)發(fā)生上述兩種疾病的患者較多。關(guān)于HFpEF合并心房顫動(dòng)的病理生理學(xué)機(jī)制、診斷的準(zhǔn)確性等方面仍存在諸多未解答的問(wèn)題。導(dǎo)管消融術(shù)治療心房顫動(dòng)可有效改善HFpEF患者預(yù)后,且優(yōu)于單純型抗心律失常藥物的治療。但目前尚缺乏患者術(shù)后生物標(biāo)志物及癥狀評(píng)分支持的相關(guān)研究。在HFpEF合并心房顫動(dòng)患者數(shù)量快速增長(zhǎng)的背景下,急需更多的系統(tǒng)性研究解答上述問(wèn)題,以此提供更多有效的、有針對(duì)性的治療方法,改善患者的生活質(zhì)量。

        利益沖突:所有作者均聲明不存在利益沖突。

        [參考文獻(xiàn)]

        [1]"" PATEL R B, VADUGANATHAN M, SHAH S J, et al. Atrial fibrillation in heart failure with preserved ejection fraction: Insights into mechanisms and therapeutics[J]. Pharmacol Ther, 2017, 176: 32–39.

        [2]"" MAGNUSSEN C, NIIRANEN T J, OJEDA F M, et al. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe)[J]. Circulation, 2017, 136(17): 1588–1597.

        [3]"" SANTHANAKRISHNAN R, WANG N, LARSON M G, et al. Atrial fibrillation begets heart failure and vice versa: Temporal associations and differences in preserved versus reduced ejection fraction[J]. Circulation, 2016, 133(5): 484–492.

        [4]"" DEL BUONO M G, IANNACCONE G, SCACCIAVI LLANI R, et al. Heart failure with preserved ejection fraction diagnosis and treatment: An updated review of the evidence[J]. Prog Cardiovasc Dis, 2020, 63(5): 570–584.

        [5]"" ZAKERI R, CHAMBERLAIN A M, ROGER V L, """et al. Temporal relationship and prognostic significance """of atrial fibrillation in heart failure patients with preserved ejection fraction: A community-based study[J]. Circulation, 2013, 128(10): 1085–1093.

        [6]"" SARTIPY U, DAHLSTR?M U, FU M, et al. Atrial fibrillation in heart failure with preserved, mid-range, and reduced ejection fraction[J]. JACC Heart Fail, 2017, 5(8): 565–574.

        [7]"" VERMOND R A, GEELHOED B, VERWEIJ N, et al. Incidence of atrial fibrillation and relationship with cardiovascular events, heart failure, and mortality: A community-based study from the Netherlands[J]. J Am Coll Cardiol, 2015, 66(9): 1000–1007.

        [8]"" HO J E, LYASS A, LEE D S, et al. Predictors of new-onset heart failure: Differences in preserved versus reduced ejection fraction[J]. Circ Heart Fail, 2013, 6(2): 279–286.

        [9]"" BADHEKA A O, RATHOD A, KIZILBASH M A, et al. Comparison of mortality and morbidity in patients "with atrial fibrillation and" heart failure with preserved versus decreased left ventricular ejection fraction[J]. Am J Cardiol, 2011, 108(9): 1283–1288.

        [10] SILVA-CARDOSO J, ZHARINOV O J, PONIKOWSKI P, et al. Heart failure in patients with atrial fibrillation is associated with a high symptom and hospitalization burden: The realiseAF survey[J]. Clin Cardiol, 2013, 36(12): 766–774.

        [11] Lip G Y, Laroche C, Popescu M I, et al. Heart failure in patients with atrial fibrillation in Europe: A report from the EUR observational research programme pilot survey on atrial fibrillation[J]. Eur J Heart Fail, 2015, 17(6): 570–582.

        [12] MENTZ R J, KELLY J P, VON LUEDER T G, et al. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction[J]. J Am Coll Cardiol, 2014, 64(21): 2281–2293.

        [13] WU Y, XIE Z, LIANG W, et al. Usefulness of CHADS2, R2CHADS2, and CHA2DS2-VASC scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients[J]. Esc Heart Fail, 2021, 8(2): 1369–1377.

        [14] HINDRICKS G, POTPARA T, DAGRES N, et al. "2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with ""the European Association for Cardio-Thoracic Surgery (EACTS): The task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J, 2021, 42(5): 373–498.

        [15] ZHU W, LIANG W, YE Z, et al. Association of physical activity and risk of atrial fibrillation in heart failure with preserved ejection fraction[J]. Nutr Metab Cardiovasc Dis, 2021, 31(1): 247–253.

        [16] OZCAN C, LI Z, KIM G, et al. Molecular mechanism "of the association between atrial fibrillation and heart failure includes energy metabolic dysregulation due to mitochondrial dysfunction[J]. J Card Fail, 2019, 25(11): 911–920.

        [17] JASIC-SZPAK E, MARWICK T H, DONAL E, et al. Prediction of AF in heart failure with preserved ejection fraction: Incremental value of left atrial strain[J]. JACC Cardiovasc Imaging, 2021, 14(1): 131–144.

        [18] CHA T J, EHRLICH J R, ZHANG L, et al. Dissociation between ionic remodeling and ability to sustain atrial fibrillation during recovery from experimental congestive heart failure[J]. Circulation, 2004, 109(3): 412–418.

        [19] SHITE J, YOKOTA Y, YOKOYAMA M. Heterogeneity and time course of improvement in cardiac function after cardioversion of chronic atrial fibrillation: Assessment of serial echocardiographic indices[J]. Br Heart J, 1993, 70(2): 154–159.

        [20] CITERNI C, KIRCHHOFF J, OLSEN L H, et al. Characterization of atrial and ventricular structural remodeling in a porcine model of atrial fibrillation induced by atrial tachypacing[J]. Front Vet Sci, 2020, 7: 179.

        [21] REDFIELD M M, BORLAUG B A. Heart failure with preserved ejection fraction: A review[J]. JAMA, 2023, 329(10): 827–838.

        [22] SAKSENA S, SLEE A, NATALE A, et al. Atrial fibrillation can adversely impact heart failure with preserved ejection fraction by its association with heart failure progression and mortality: A post-hoc propensity score-matched analysis of the TOPCAT Americas trial[J]. Europace, 2023, 25(5): euad095.

        [23] PATEL R B, GREENE S J, XU H, et al. Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in gt;400 000 participants in the get with the guidelines-heart failure registry[J]. Eur J Heart Fail, 2023, 25(1): 63–73.

        [24] PATEL R B, VADUGANATHAN M, FELKER G M, "et al. Physical activity, quality of life, and biomarkers "in atrial fibrillation and heart failure with preserved ejection fraction (from the NEAT-HFpEF trial)[J]. Am J Cardiol, 2019, 123(10): 1660–1666.

        [25] KOTECHA D, CHUDASAMA R, LANE D A, et al. Atrial fibrillation and heart failure due to reduced versus preserved ejection fraction: A systematic review and Meta-analysis of death and adverse outcomes[J]. Int J Cardiol, 2016, 203: 660–666.

        [26] KELLY J P, MENTZ R J, MEBAZAA A, et al. Patient selection in heart failure with preserved ejection "fraction clinical trials[J]. J Am Coll Cardiol, 2015, 65(16): 1668–1682.

        [27] SARTIPY U, SAVARESE G, DAHLSTR?M U, et al. Association of heart rate with mortality in sinus rhythm and atrial fibrillation in heart failure with preserved ejection fraction[J]. Eur J Heart Fail, 2019, 21(4): 471–479.

        [28] SOBUE Y, WATANABE E, LIP G Y H, et al. Thromboembolisms in atrial fibrillation and heart failure patients with a preserved ejection fraction (HFpEF) compared to those with a reduced ejection fraction (HFrEF)[J]. Heart Vessels, 2018, 33(4): 403–412.

        [29] LIU G, LONG M, HU X, et al. Meta-analysis of atrial fibrillation and outcomes in patients with heart failure and preserved ejection fraction[J]. Heart Lung Circ, 2021, 30(5): 698–706.

        [30] SANTEMA B T, KLOOSTERMAN M, VAN GELDER I C, et al. Comparing biomarker profiles of patients with heart failure: Atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction[J]. Eur Heart J, 2018, 39(43): 3867–3875.

        [31] MACHINO-OHTSUKA T, SEO Y, ISHIZU T, et al. Relationships between maintenance of sinus rhythm and clinical outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation[J].""" J Cardiol, 2019, 74(3): 235–244.

        [32] MARROUCHE N F, BRACHMANN J, ANDRESEN D, et al. Catheter ablation for atrial fibrillation with heart failure[J]. N Engl J Med, 2018, 378(5): 417–427.

        [33] DU X, LUO C, SHEN C, et al. The impact of empirical Marshall vein ethanol infusion as a first-choice intraoperative strategy on the long-term outcomes in patients with persistent atrial fibrillation undergoing mitral isthmus ablation[J]. Front Cardiovasc Med, 2023, 10: 1223064.

        [34] BLOCKHAUS C, GUELKER J E, FEYEN L, et al. Pulsed field ablation for pulmonary vein isolation: Real-world experience and characterization of the" antral lesion size compared with cryoballoon ablation[J]."""" J Interv Card Electrophysiol, 2023, 66(3): 567–575.

        [35] EITEL C, INCE H, BRACHMANN J, et al. Atrial fibrillation ablation strategies and outcome in patients with heart failure: Insights from the German ablation registry[J]. Clin Res Cardiol, 2019, 108(7): 815–823.

        [36] FUKUI A, TANINO T, YAMAGUCHI T, et al. Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction[J]. J Cardiovasc Electrophysiol, 2020, 31(3): 682–688.

        [37] MACHINO-OHTSUKA T, SEO Y, ISHIZU T, et al. Efficacy, safety, and outcomes of catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction[J]. J Am Coll Cardiol, 2013, 62(20): 1857–1865.

        [38] SUGUMAR H, NANAYAKKARA S, VIZI D, et al."" A prospective study using invasive haemodynamic measurements following catheter ablation for AF and early HFpEF: Stall AF-HFpEF[J]. Eur J Heart Fail, 2021, 23(5): 785–796.

        (收稿日期:2024–09–13)

        (修回日期:2025–01–09)

        通信作者:楊一民,電子信箱:yym216@126.com

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