摘要
目的：探讨影响持续性心房颤动（房颤）消融术后复发的因素。方法：入选症状明显、药物治疗无效的持续性房颤（持续时间〉7d）患者30例，在房颤心律下，通过三维标测系统CARTO指导行环肺静脉线性消融隔离肺静脉。隔离肺静脉后房颤仍然持续者行电击复律，术前及术中有典型心房扑动（房扑）者同时行三尖瓣环峡部消融。分别于消融前和完成预定消融策略后测量房颤周长。术后进行系统随访，根据房颤是否复发行单因素及多因素分析，确定消融成功与否的影响因素。结果：30例患者均完成双侧环肺静脉线性消融，6例恢复窦性心律，4例转为典型房扑者继续三尖瓣峡部消融，4例左房房扑及16例房颤仍然持续者行体外电击复律。随访期间，50．0％（15／30）患者出现早期（术后1个月）复发；继续随访中，40．0％（6／15）的早期复发患者实现延迟治愈，1例出现晚期复发。平均随访6～14（8．6±2．4）个月后，66．7％（20／30）的患者达到成功标准。单因素分析显示，成功组较复发组患者消融前后房颤周期变异程度较大[（14．36±10．52）％：（4．15±3．91）％，P=0．006]、消融后房颤周长显著延长，早期复发率显著较低（30．0％：80．0％，P=0．013）。多因素分析显示，消融后房颤周长的变化：OR=21．345，95％CI为1．429～318．795，P=0．026；术后早期复发：0R=1．27，95％CI为1．020～1．573，P=0．033。结论：消融前后房颤周长无显著性变化及术后早期复发为持续性房颤消融术后房颤复发的独立预测因素，术中监测房颤周期变化可以在一定程度上筛选那些需要额外消融的患者。
Objective：To investigate the factor（s） predicting the recurrence of atrial fibrillation （Af） after catheter ablation of persistent Af. Method：The patients with persistent Af （lasted 〉7 days） entered this study, all were symptomatic and drug-refractory. Pulmonary vein isolation （PVI） was achieved via circumferential pulmona ry vein ablation （CPVA） guided by CARTO system during ongoing Af. Cardioversion was performed to restore sinus rhythm if Af was still sustainable after PVI and tricuspid annulus isthmus （TAD ablation was carried out only in patients with documented or organized typical atrial flutter （AF）. The circle length （CL） of atrium was measured manually with online calipers by averaging 30 consecutive cycles of distal coronary sinus recording. Systematic follow up was conducted after ablation, univariable and multivariable analysis were carried out to determinate the factor （ s ） predicting the recurrence of Af. Result ： Thirty patients with persistent Af underwent CPVA to achieve PVI. After PVI, sinus rhythm was restored in 6 patients, TAI ablation was performed in 4 patients with documented or organized typical AF, and cardioversion was performed in 4 patients with left AF and 16 patients with sustainable Af. During follow up, recurrent atrial tachyarrhythm （ATa） was documented in 50.0% （15/30） of patients, 40. 0% （6/15） of those recurrent cases achieved delayed cure during continuous follow up, late relapse was documented in 1 patient. After a mean of 8.6±2.4 （6-14） months follow up, 66. 7% （20/30） of patients freed from any ATa. Univariable analysis revealed prolonged atrial CL （[ 14.36 ±10. 52]% vs[ 4.15 ±3.91]%, P = 0. 006）during ablation and lower early recurrence （30% vs 80% ,P=0. 013） were associated with Ata free during follow up, and multivariable analysis revealed less prolonged CL of atrial （OR= 21. 345,95 % CI：1. 429--318. 795, P= 0. 026） during ablation and early recurrence （OR = 1.27,95 % CI： 1. 020-- 1. 573, P = 0. 033） were the independent risk factors responsible for the recurrence of Ata. Conclusion： Less prolonged CL of atrium during ablation and early recurrence were associated with the recurrence of Ata. Monitor of atrial CL could be employed to select those needing extra PV ablation.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2008年第8期570-574,共5页
Journal of Clinical Cardiology
关键词
心房颤动
射频消融术
预后
Atrial fibrillation
Catheter ablation
Prognosis
