Europace：持续性房颤伴心衰患者电复律无效可考虑导管消融。

心房颤动的导管消融可使心衰患者的射血分数（LVEF）上升，然而这种LVEF上升并不确切，与心衰发生的病因明显相关。由于导管消融属于有创操作，具有一定的风险性，因此在消融之前必须确定转复窦律后LVEF能明显上升。以往的临床经验表明，快心室率房颤导致的心力衰竭在电复律后LVEF明显上升，因此对于电复律无效的患者进行导管消融可能明显改善患者的心衰症状，但目前还缺乏相关的临床研究。

据此，Bortone A等进行了一项临床研究，近来发表在Europace杂志上，该研究的对象为持续性房颤伴LVEF<40%的心衰患者，这些患者均对电复律无效，主要研究持续性房颤导管消融后心衰的改善情况。

该研究共入选自2008年1月至2011年9月于作者单位治疗的129例充血性心力衰竭伴持续性房颤的患者，其中334例患者电复律无效，且这些患者的心力衰竭可能与快速心室率导致的左心功能不全相关。所有患者均进行了导管消融，并进行了严密的随访。结果显示：所有患者进行了平均1.9次的导管消融，所有患者在进行最后一次消融后平均随访17.6个月。所有患者均维持窦律，NYHA心功能分级从平均2.8级下降至1级，LVEF值平均从30.4上升至54.6%，两者差别均存在显著统计学意义。

通过该项研究可得出以下结论：对于持续性房颤伴左心功能下降的患者，在除外可导致左心功能下降的其他原因后，导管消融可成功改善患者的心力衰竭，然而为维持窦律，许多患者需进行一次以上的导管消融，因此提高持续性房颤导管消融的成功率仍然值得我们重视。

Catheter ablation in selected patients with depressed left ventricular ejection fraction and persistent atrial fibrillation unresponsive to current cardioversion.
Abstract
AIMS: In congestive heart failure (CHF) patients with persistent atrial fibrillation (AF), direct current cardioversion (DCC) may reveal participation of tachycardiamediated process to left ventricular (LV) dysfunction by restoring sinus rhythm (SR). However, if DCC fails to restore SR, patients' management remains challenging.The aim of the study was to assess the AF catheter ablation benefit in a selected group of CHF patients with LV ejection fraction (LVEF) <40% and persistent AF unresponsive to DCC, in whom a tachycardia-mediated process is thought to be predominant.METHODS AND RESULTS: Between January 2008 and September 2011, among 129 CHF patients with persistent AF referred to our institution, 34 (63.8 ± 9-year old, 24 men) presented AF refractory to DCC with an estimated high likelihood of tachycardia-mediated LV dysfunction according to a specific set of criteria. These 34 patients underwent stepwise AF ablation and were closely followed up. After a mean 1.9 AF ablation procedures per patient and 17.6 ± 7 months after the last procedure, all patients were in SR. The New York Heart Association class improved from 2.8 ± 0.3 to 1 ± 0.2 (P< 0.001) and the LVEF increased from 30.4 ± 6 to 54.6 ± 6% (P< 0.0001) after 3-6 months of SR, with a persistent benefit as long as the SR was maintained.CONCLUSION: Atrial fibrillation catheter ablation in selected CHF patients with persistent AF refractory to DCC and without any other evidence for secondary LV dysfunction leads to a substantial LVEF improvement in the majority of them. However, redo procedures are frequent in order to achieve mid-term SR maintenance.