Nekuchembera kwevanhu uye kufambira mberi kwekuongororwa kwechirwere chemoyo uye kurapwa, kusagadzikana kwemoyo (moyo kusakundikana) ndiyo chete chirwere chemwoyo chiri kuwedzera kuitika uye kupararira.Huwandu hweChina hwevarwere vane chirwere chemoyo chisingaperi muna 2021 vangangoita mamirioni gumi nematanhatu, vanotarisirwa kusvika 16.14 miriyoni ne2030, kufa kwemoyo kukundikana kuchasvika mamirioni 1.934.
Kukundikana kwemoyo uye atrial fibrillation (AF) inowanzogara pamwe chete.Kusvikira ku50% yevarwere vatsva vane mwoyo yakakundikana vane atrial fibrillation;Pakati pezviitiko zvitsva zveatrial fibrillation, chinenge chikamu chimwe muzvitatu chine moyo kusakundikana.Zvakaoma kusiyanisa pakati pechikonzero nemigumisiro yekukundikana kwemoyo uye atrial fibrillation, asi muvarwere vane mwoyo kukundikana uye atrial fibrillation, zvidzidzo zvakawanda zvakaratidza kuti catheter ablation inoderedza zvakanyanya ngozi yezvose-zvinokonzera rufu uye kuora mwoyo kuverenga.Zvisinei, hapana chimwe chezvidzidzo izvi chaisanganisira varwere vane chirwere chekupedzisira chekushaya mwoyo pamwe chete neatrial fibrillation, uye mazano achangobva kuitika pamusoro pekukundikana kwemoyo uye kubvisa kunosanganisira kubvisa seKirasi II kurudziro yevarwere vane chero rudzi rweatrial fibrillation uye kuderedzwa kwe ejection chikamu, asi. amiodarone ikurudziro yeKirasi I
Chidzidzo cheCASTLE-AF, chakaburitswa muna 2018, chakaratidza kuti kune varwere vane atrial fibrillation yakasanganiswa nekutadza kwemoyo, catheter ablation yakaderedza zvakanyanya njodzi yezvikonzero-zvese kufa uye moyo kutadza kuverenga zvichienzaniswa nemushonga.Mukuwedzera, zvidzidzo zvakawanda zvakasimbisawo zvikomborero zvecatheter ablation mukuvandudza zviratidzo, kudzorera kugadziriswa kwemwoyo, uye kuderedza atrial fibrillation load.Zvisinei, varwere vane atrial fibrillation pamwe chete nekuguma-danho rekushaya mwoyo kunowanzova kunze kwehuwandu hwekudzidza.Kune varwere ava, kuendeswa panguva yakakodzera kwekuiswa kwemoyo kana kuiswa kwechigadzirwa cheruboshwe chekubatsira (LVAD) chinoshanda, asi kuchine kushaikwa kwehumbowo hwezvehutano hunobva pauchapupu hwekuti catheter ablation inogona kuderedza rufu uye kunonoka kuiswa kweLVAD uchimirira mwoyo. transplantation.
Chidzidzo cheCASTLE-HTx chaive chepakati-chimwechete, chakavhurika-label, muongorori-akatanga randomized controlled controlled kuyedza kwepamusoro-soro.Chidzidzo ichi chakaitwa kuHerz- und Diabeteszentrum Nordrhein-Westfale, nzvimbo yekutumira moyo kuGermany iyo inoita makumi masere ekutapurirana pagore.Huwandu hwevarwere ve194 vane yekupedzisira-nhanho yekutadza kwemoyo ine symptomatic atrial fibrillation vakaongororwa kuti vanokodzera kuisirwa moyo kana kuisirwa kweLVAD vakanyoreswa kubva munaNovember 2020 kusvika May 2022. Varwere vese vaive nemidziyo yemoyo inoisirwa nemoyo inoenderera mberi ichitarisisa.Vese varwere vaive vakasarudzika muchiyero che1: 1 kuti vagamuchire catheter ablation uye inotungamirwa-inotungamirwa mishonga kana kugamuchira mushonga wega.Mhedziso yekutanga yaive musanganiswa wezvese-zvinokonzera rufu, LVAD kuisirwa, kana emergency moyo transplantation.Secondary endpoints yaisanganisira zvose-zvinokonzera rufu, kuiswa kweLVAD, kukurumidza kuchinjwa kwemwoyo, kufa kwemwoyo, uye kuchinja muchikamu chekuruboshwe ventricular ejection (LVEF) uye atrial fibrillation load pa6 uye 12 mwedzi yekutevera.
Muna Chivabvu 2023 (gore rimwe chete mushure mekunyoresa), iyo Data uye Safety Monitoring Committee yakawana mukuongororwa kwechinguvana kuti zviitiko zvekutanga zvekupedzisira pakati pemapoka maviri aya zvaive zvakasiyana uye zvakakura pane zvaitarisirwa, kuti boka rekubvisa catheter raive rakanyanya kushanda uye mukutevedzera. mutemo weHaybittle-Peto, uye akakurudzira kuregedzerwa nekukurumidza kwechirongwa chemushonga chakatemerwa muchidzidzo.Vafereferi vakagamuchira kurudziro yekomiti yekushandura protocol yekudzidza kuti ideredze data rekutevera rekupera kwaMay 15, 2023.
Kuiswa kwemoyo uye kuiswa kweLVAD kwakakosha kuvandudza kufungidzira kwevarwere vane kuguma-nhanho yekukundikana kwemoyo pamwe chete neatrial fibrillation, zvisinei, zviwanikwa zvishoma zvevanopa uye zvimwe zvinhu zvinoderedza kushandiswa kwavo kwakakura kusvika pamwero.Tichiri kumirira kuisirwa mwoyo uye LVAD, chii chimwe chatingaite kunonoka kufambira mberi kwechirwere rufu rusati rwatanga?Iyo CASTLE-HTx chidzidzo pasina mubvunzo ine kukosha kukuru.Izvo hazvisi kungosimbisa mabhenefiti ecatheter ablation kune varwere vane yakakosha AF, asi zvakare inopa inovimbisa nzira yekusvikika kwepamusoro kune varwere vane yekupedzisira-nhanho yekutadza kuomarara neAF.
Nguva yekutumira: Sep-02-2023