摘要
目的:分析心房颤动(房颤)经导管射频消融术后晚期复发的相关因素。方法:房颤患者117例接受经导管射频消融术治疗,术前进行常规检查评估,在CARTO三维标测系统指导下行左房环肺静脉消融,必要时加行左房线性消融、右房线性消融等策略。如果在消融结束后心电监护仍为房颤心律,则行体外电复律。通过术后随访(>3个月)确定房颤消融术后是否复发,收集相关的随访资料分析房颤术后晚期复发的预测因素。结果:1所有患者均完成环肺静脉隔离。58例患者在环肺静脉消融基础上加行左房线性消融、右房线性消融等方法。37例房颤患者在消融后房颤仍持续,经体外电转复均恢复窦律。32例(27.3%)患者在术后晚期复发。2单因素分析显示性别、并发器质性心脏病、房颤病程、持续性房颤、左房内径、左室射血分数和复律与术后房颤晚期复发相关(均P<0.05)。3经多因素分析后仅有性别、左房内径、房颤病程是房颤晚期复发的独立预测指标(分别P<0.05,P<0.05,P<0.01)。结论:性别、房颤病程、左房内径是房颤导管消融术后晚期复发的独立预测因素。
AIM： To investigate the predictors of late recurrence of atrial tachyarrhythmias after catheter ablation in patients with atrial fibrillation （AF）. METHODS： A total of 117 patients （81 males, 36 females） with AF （paroxysmal, 80; persistent, 37） who received radiofrequency catheter ablation were enrolled in this study. All patients underwent circumferential pulmonary vein ablation （CPVA） guided by three-dimensional electroanatomical mapping system （CARTO）. The endpoint of CPVA was pulmonary vein isolation （PVI）. Left atrial linear ablations and right atrial linear ablations would be performed after PVI if AF could not be terminated at the end of ablation. External cardioversion was needed if AF was still sustained. Uni- and multivariate analysis were carried out to assess the predictive value of 18 clinical and procedural variables for late recurrence （ 〉3 months） of AF after the initial catheter ablation procedure. RESULTS： PVI was achieved in all patients. Left atrial linear ablations and right atrial linear ablations were performed after PVI in 58 patients. AF remained after radiofrequency catheter ablation in 37 patients. However, all external cardioversions were successful. Thirty-two patients （27.3%） had late recurrence of AF. Univariate analysis showed that six clinical variables were related to the late recurrence of AF： AF duration; persistent AF; presence of associated structural heart disease; left atrial enlarge- ment ; LVEF ; and no termination of AF during energy delivery and need of cardioversion （ P 〈 0. 05 ）. Multivariate analysis found that only gender, AF duration and left atrial enlargement could predict the late recurrence of AF （P =0. 0261 ; 0. 0185 ; 0. 0002）. CONCLUSION： AF duration, persistent AF, presence of associated structural heart disease, left atrial enlargement, LVEF, and no termination of AF during energy delivery and need of cardioversion are related to the late recurrence of AF. Gender, AF duration and left atrial enlargement are independent predictors for the late recurrence of AF.
出处
《心脏杂志》
CAS
2015年第3期287-290,共4页
Chinese Heart Journal
基金
哈尔滨市科技创新人才研究专项资金项目资助(2011RFQYS068)
哈尔滨市科技攻关计划项目资助(2007AA3CS082-2)
关键词
心房颤动
肺静脉
导管消融
复发
预测因素
atrial fibrillation
pulmonary vein
catheter ablation
recurrence
predictor
作者简介
卢晓娟，住院医师，硕士生Email：juanzi11123@sina．com
共同第一作者：李述峰，副主任医师，博士Email：drlishufeng@163．com
通讯作者：张丽丽，主任医师，主要从事心律失常发病机制和临床治疗研究Email：drzhanglili@163．com
