持续性心房颤动伴右束支阻滞的病因及预后分析
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摘要
目的探讨持续性心房颤动伴右束支阻滞的病因及预后。方法对2006年4月至2015年3月于我院住院治疗并被诊断为持续性房颤伴右束支阻滞的128例患者的临床资料进行回顾性分析,归纳其病因及预后。结果 128例患者中,男90例、女38例,平均(71.13±14.20)岁。在所有病因中,心脏瓣膜病67例、冠心病18例、扩张型心肌病8例、肥厚型心肌病2例、先天性心脏病14例、高血压病10例、未明原因的房颤伴右束支阻滞9例。其中,心脏瓣膜病占52.34%,冠心病占14.06%。所有入选患者中,有46例行手术治疗,24例行瓣膜置换术(其中,瓣膜置换术+起搏器植入术1例、瓣膜置换术+房颤射频消融术5例),9例行永久性心脏起搏器植入术,6例行房颤射频消融术,8例行冠脉支架植入术,4例行房间隔缺损修补术(其中,单独行房间隔缺损修补术2例),2例行室间隔修补术(其中,单独行室间隔缺损修补术1例),1例行心脏移植术,1例行冠状动脉-肺动脉瘘修补术;其余患者均接受药物保守治疗。左室射血分数<50%的有19例,主要为心脏瓣膜病、冠心病或扩张型心肌病患者。所有病例最长随访8年,最短随访1年;经电话或门诊随访发现,所有入选患者中死亡50例(39.06%),继续门诊随诊或院外规律服药治疗55例(42.97%),随访过程中无法联系导致病例失访23例(17.97%)。所有入选患者中合并脑梗死的有20例(15.63%),其预后均较差。结论持续性心房颤动伴右束支阻滞的病因多种多样,主要为心脏瓣膜病。这类患者预后不佳,会出现各种心脑血管并发症,且死亡率较高。
Objective To explore the pathogeny and prognosis of permanent atrial fibrillation( AF) complicating right bundle branch block( RBBB). Methods Retrospective analysis was carried out on 128 patients who had been admitted in our hospital from April 2006 to March 2015 and diagnosed with permanent AF complicating RBBB. The pathogeny and prognosis was summarized. Results Among the 128 patients,there were 90 males and38 females at an average age of( 71. 13 ± 14. 20) years old. Of all the causes,there were 67 cases with valvular heart disease,18 cases with coronary heart disease,8 cases with dilated cardiomyopathy,2 cases with hypertrophic cardiomyopathy,14 cases with congenital heart disease,10 cases with hypertension,9 cases with AF complicating RBBB of unknown cause. The patients diagnosed with valvular heart disease accounted for 52. 34% in all the research objects and cases with coronary heart disease accounted for 14. 06%. Among all the enrolled patients,46 cases underwent surgical treatments: 24 accepted valve replacement( including 1 case accepting valve replacementplus pacemaker implantation and 5 cases accepting valve replacement plus radiofrequency ablation of AF),9 patients were implanted with permanent cardiac pacemaker,6 patients underwent radiofrequency ablation of AF,8 patients were implanted with coronary stent,4 cases underwent repair of atrial septal defect( including 2 cases accepting the surgery alone),2 cases underwent repair of ventricular septal defect( including 1 case accepting the surgery alone),1 patient accepted heart transplantation,1 patient accepted repair of coronary-artery-pulmonary-artery fistula. Other patients underwent conservative medication. In 19 patients mainly those with valvular heart disease,coronary heart disease or dilated cardiomyopathy,left ventricle ejection fraction was less than 50%. All the patients were followed up by phone calls or outpatient visits within a period of 1-8 years. During the follow-up,50 cases( 39. 06%) died,55 cases( 42. 97%) continued to be followed up in outpatient clinic or accepted regular medication therapy outside the hospital,and 23( 17. 97%) were at loss of follow-up due to being out of contact.Twenty patients( 15. 63%) in all were complicated by cerebral infarction with poor prognosis. Conclusion The pathogeny of permanent AF complicating RBBB is varied,mainly valvular heart disease. The patients have poor prognosis with various cardiovascular and cerebrovascular complications at high mortality rates.
Objective To explore the pathogeny and prognosis of permanent atrial fibrillation( AF) complicating right bundle branch block( RBBB). Methods Retrospective analysis was carried out on 128 patients who had been admitted in our hospital from April 2006 to March 2015 and diagnosed with permanent AF complicating RBBB. The pathogeny and prognosis was summarized. Results Among the 128 patients,there were 90 males and38 females at an average age of( 71. 13 ± 14. 20) years old. Of all the causes,there were 67 cases with valvular heart disease,18 cases with coronary heart disease,8 cases with dilated cardiomyopathy,2 cases with hypertrophic cardiomyopathy,14 cases with congenital heart disease,10 cases with hypertension,9 cases with AF complicating RBBB of unknown cause. The patients diagnosed with valvular heart disease accounted for 52. 34% in all the research objects and cases with coronary heart disease accounted for 14. 06%. Among all the enrolled patients,46 cases underwent surgical treatments: 24 accepted valve replacement( including 1 case accepting valve replacementplus pacemaker implantation and 5 cases accepting valve replacement plus radiofrequency ablation of AF),9 patients were implanted with permanent cardiac pacemaker,6 patients underwent radiofrequency ablation of AF,8 patients were implanted with coronary stent,4 cases underwent repair of atrial septal defect( including 2 cases accepting the surgery alone),2 cases underwent repair of ventricular septal defect( including 1 case accepting the surgery alone),1 patient accepted heart transplantation,1 patient accepted repair of coronary-artery-pulmonary-artery fistula. Other patients underwent conservative medication. In 19 patients mainly those with valvular heart disease,coronary heart disease or dilated cardiomyopathy,left ventricle ejection fraction was less than 50%. All the patients were followed up by phone calls or outpatient visits within a period of 1-8 years. During the follow-up,50 cases( 39. 06%) died,55 cases( 42. 97%) continued to be followed up in outpatient clinic or accepted regular medication therapy outside the hospital,and 23( 17. 97%) were at loss of follow-up due to being out of contact.Twenty patients( 15. 63%) in all were complicated by cerebral infarction with poor prognosis. Conclusion The pathogeny of permanent AF complicating RBBB is varied,mainly valvular heart disease. The patients have poor prognosis with various cardiovascular and cerebrovascular complications at high mortality rates.
引文
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[7]董剑廷,孙艳香,李飞,等.新发房颤合并右束支阻滞患者的临床观察[J].江苏实用心电学杂志,2014,23(2):94-96.
[8]Nielsen JB,Olesen MS,Tango M,et al.Incomplete right bundle branch block:a novel electrocardiographic marker for lone atrial fibrillation[J].Europace,2011,13(2):182-187.
[9]Pine MB,Oren M,Ciafone R,et al.Excess mortality and morbidity associated with right bundle branch and left anterior fascicular block[J].J Am Coll Cardiol,1983,1(15):1207-1212.
[10]王慧敏,吴倩芸,王凯,等.完全性右束支传导阻滞在评价急性心力衰竭患者预后中的价值[J].临床心血管病杂志,2017,33(9):836-840.
[2]Lloyd-Jones D,Adams RJ,Brown TM,et al.Heart disease and stroke statistics 2010 update:a report from the American Heart Association[J].Circulation,2010,121(7):948-954.
[3]Fuster V,Rydén LE,Asinger RW,et al.ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation—executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences(Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation):developed in collaboration with the North American Society of Pacing and Electrophysiology[J].J Am Coll Cardiol,2001,38(4):1231-1266.
[4]Fuster V,Rydén LE,Cannom DS,et al.ACC/AHA/ESC2006 guidelines for the management of patients with atrial fibrillation—executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences(Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation):developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society[J].Eur Heart J,27(16):1979-2030.
[5]Bussink BE,Holst AG,Jespersen L,et al.Right bundle branch block:prevalence,risk factors,and outcome in the general population:results from the Copenhagen City Heart Study[J].Eur Heart J,2013,34(2):138-146.
[6]董剑廷,李飞,袁勇,等.急性心肌炎并发新发心房颤动及右束支传导阻滞的诊治体会[J].中国心脏起搏与心电生理杂志,2012,26(2):173-174.
[7]董剑廷,孙艳香,李飞,等.新发房颤合并右束支阻滞患者的临床观察[J].江苏实用心电学杂志,2014,23(2):94-96.
[8]Nielsen JB,Olesen MS,Tango M,et al.Incomplete right bundle branch block:a novel electrocardiographic marker for lone atrial fibrillation[J].Europace,2011,13(2):182-187.
[9]Pine MB,Oren M,Ciafone R,et al.Excess mortality and morbidity associated with right bundle branch and left anterior fascicular block[J].J Am Coll Cardiol,1983,1(15):1207-1212.
[10]王慧敏,吴倩芸,王凯,等.完全性右束支传导阻滞在评价急性心力衰竭患者预后中的价值[J].临床心血管病杂志,2017,33(9):836-840.