房颤患者射频消融的临床疗效及术后早期复发的危险因素
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摘要
目的探讨射频消融术治疗房颤的临床效果及其影响术后早期复发的危险因素。方法选取首次行导管射频消融术并完成术后随访的房颤患者603例,记录射频消融术后恢复窦性心律情况及其术后30 d心包填塞、食管瘘、动静脉瘘、假性动脉瘤、动脉栓塞等不良事件发生情况,术后1、3、6、12个月12导联心电图或24 h动态心电图有无持续时间>30 s的房性心律失常,有无任何胸闷、心悸症状及出现症状时的心电图表现。患者术后均随访1年以上,记录术后早期房颤复发情况,采用多因素回归分析房颤早期复发的危险因素。结果 603例患者射频消融术后均成功恢复窦性心律。术后30 d发生不良事件18例,无死亡及其他严重并发症。随访期间,282例患者(46.8%)出现房颤早期复发(术后3个月内),180例(29.8%)出现房颤晚期复发(术后3个月以后)。早期复发患者中,有胸闷、心悸症状270例(96%),无症状12例(4%)。早期复发患者中有138例(48.9%)术后3个月后未再发作房性心律失常,即出现延迟治愈。多因素回归分析显示,房颤病程、持续性房颤、合并高血压、心电图细f波增加、左房前后径增大、BMI增高、女性与房颤早期复发有关(P均<0.05)。结论房颤病程及类型、高血压病史、左房增大、心电图f波类型、体质量超标、女性是房颤早期复发的独立影响因素。
Objective To investigate the clinical efficacy of radiofrequency catheter ablation( RFCA) in the treatment of atrial fibrillation( AF) and the risk factors of early recurrence. Methods A total of 603 AF patients who performed the first-time RFCA were selected and their postoperative follow-up was included in the study. The recovery of sinus rhythm after radiofrequency ablation and the occurrence of adverse events such as 30-day postoperative pericardial tamponade,esophageal fistula,arteriovenous fistula,pseudoaneurysm and arterial embolism were recorded. The occurrence of symptomatic atrial arrhythmias recorded by 12-lead electrocardiogram( ECG) or 24 h electrocardiogram monitor( > 30 seconds) after ablation in the 1 st,3 rd,6 th,and 12 th month were observed. The ECG results were recorded when the patients felt chest tightness and palpitation. All patients were followed up for more than 1 year and the recurrence of AF was recorded. The risk factors for early recurrence of AF after ablation were analyzed by multivariate regression analysis. Results All of the 603 patients restored sinus rhythm successfully after RFCA. During the follow-up,there were 18 cases of 30-day adverse events without death. totally 282( 46. 8%) patients experienced early recurrence of AF during the 3-month after RFCA and 180( 29. 8%) patients experienced late recurrence of AF after the 3-months after RFCA; 270( 96%) cases of patients with early recurrence of AF experienced the symptoms of chest tightness and palpitation,while 12 cases experienced no symptoms. There were 138 cases( 48. 9%) of patients with early recurrrence who had no recurrence of atrial arrhythmia at 3 months after RFCA,which was delayed effect. Multivariate regression analysis revealed that the longer duration of AF,permanent AF,history of hypertension,electrocardiogram( ECG) f-wave amplitude < 0. 01 m V,left atrial diameter > 40 mm,higher BMI,and female were associated with early recurrence of Af( all P < 0. 05). Conclusion The duration of AF and type of AF,history of hypertension,type of ECG f-wave,left atrial dilation,obesity,and female are independent risk factors of early recurrencen of AF after RFCA.
Objective To investigate the clinical efficacy of radiofrequency catheter ablation( RFCA) in the treatment of atrial fibrillation( AF) and the risk factors of early recurrence. Methods A total of 603 AF patients who performed the first-time RFCA were selected and their postoperative follow-up was included in the study. The recovery of sinus rhythm after radiofrequency ablation and the occurrence of adverse events such as 30-day postoperative pericardial tamponade,esophageal fistula,arteriovenous fistula,pseudoaneurysm and arterial embolism were recorded. The occurrence of symptomatic atrial arrhythmias recorded by 12-lead electrocardiogram( ECG) or 24 h electrocardiogram monitor( > 30 seconds) after ablation in the 1 st,3 rd,6 th,and 12 th month were observed. The ECG results were recorded when the patients felt chest tightness and palpitation. All patients were followed up for more than 1 year and the recurrence of AF was recorded. The risk factors for early recurrence of AF after ablation were analyzed by multivariate regression analysis. Results All of the 603 patients restored sinus rhythm successfully after RFCA. During the follow-up,there were 18 cases of 30-day adverse events without death. totally 282( 46. 8%) patients experienced early recurrence of AF during the 3-month after RFCA and 180( 29. 8%) patients experienced late recurrence of AF after the 3-months after RFCA; 270( 96%) cases of patients with early recurrence of AF experienced the symptoms of chest tightness and palpitation,while 12 cases experienced no symptoms. There were 138 cases( 48. 9%) of patients with early recurrrence who had no recurrence of atrial arrhythmia at 3 months after RFCA,which was delayed effect. Multivariate regression analysis revealed that the longer duration of AF,permanent AF,history of hypertension,electrocardiogram( ECG) f-wave amplitude < 0. 01 m V,left atrial diameter > 40 mm,higher BMI,and female were associated with early recurrence of Af( all P < 0. 05). Conclusion The duration of AF and type of AF,history of hypertension,type of ECG f-wave,left atrial dilation,obesity,and female are independent risk factors of early recurrencen of AF after RFCA.
引文
[1]籍振国,刘志红,马国平,等.心房颤动的流行病学现状及危害[J].医学与哲学:临床决策论坛版,2009,30(3):10-12.
[2]Brachmann J,Lewalter T,Kuck KH,et al.Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia:insights from the German ablation registry[J].Eur Heart J,2017,38(17):1317-1326.
[3]Arbelo E,Brugada J,Lundqvist CB,et al.Contemporary management of patientsundergoing atrial fibrillation ablation:in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry[J].Eur Heart J,2017,38(17):1303-1316.
[4]Saliba W,Schliamser JE,Lavi I,et al.Catheter ablation of atrial fibrillation isassociatedwith reduced risk ofstroke andmortality:a propensity score-matched analysis[J].Heart Rhythm,2017,14(5):635-642.
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[8]Jiang H,Lu Z,Lei H,et al.Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease[J].Interv Card Electrophysiol,2006,15(3):157-163.
[9]Berkowitsch A,Greiss H,Vukajlovic D,et al.Usefulness of atrial fibrillation burden as a predictor for success of pulmonary vein isolation[J].Pac Clin Electrophysiol,2005,28(12):1292-1301.
[10]Berruezo A,Tamborero D,Mont L,et al.Pre-procedural predictors of atrial fibrillation recurrence after circumferntial pulmonary vein ablation[J].Eur Heart J,2007,28(7):836-841.
[11]Wachtell K,Lehto M,Gerdts E,et al.AngiotensinⅡreceptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenoiol:the Losartan Intervention For End Piont Reduction in Hypertensiong(LIFE)Study[J].J Am Coll Cardiol,2005,45(5):712-719.
[12]Oral H,Knight BP,Tada H,et al.Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation[J].Circulation,2002,105(9):1077-1081.
[13]Haissaguerre M,Jais P,Shah DC,et al.Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers[J].Card Electrophysiol,2000,11(1):2-10.
[14]Jalife J,Kaur K.Atrial remodeling,fibrosis,and atrial fibrillation[J].Trend Cardiovascul Med,2015,25(6):475-484
[15]Hsu NW,Lin YJ,Tai CT,et al.Frequency analysis of the fibrillatory activity from surface ECG lead V1 and intracardiac recordings:implications for mapping of AF[J].Europace,2008,10(4):438-443.
[16]Maura M,Johannes B,Thorsten L,et al.Sex-related outcome of atrial fibrillation ablation:insights from the German ablation registry[J].Heart Rhythm,2016,13(9):1837-1844.
[17]Dimipi P,Prasant M,Luigi D,et al.Outcomes and complications of catheter ablation for atrial fibrillation in females[J].Heart Rhythm,2010,7(2)167-172.
[18]Jannik LP,Gunnar HG,Jim H,et al.Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014:a nationwide Danish cohort study[J].Eur Heart J,2018,39(6):442-449.
[19]Friberg L,Tabrizi F,Englund A,et al.Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death:data from Swedish health registries[J].Eur Heart J,2016,37(31):2478-2487.
[2]Brachmann J,Lewalter T,Kuck KH,et al.Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia:insights from the German ablation registry[J].Eur Heart J,2017,38(17):1317-1326.
[3]Arbelo E,Brugada J,Lundqvist CB,et al.Contemporary management of patientsundergoing atrial fibrillation ablation:in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry[J].Eur Heart J,2017,38(17):1303-1316.
[4]Saliba W,Schliamser JE,Lavi I,et al.Catheter ablation of atrial fibrillation isassociatedwith reduced risk ofstroke andmortality:a propensity score-matched analysis[J].Heart Rhythm,2017,14(5):635-642.
[5]Oral H,Knight BP,Ozaydin M,et al.Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation[J].J Am Coll Cardiol,2002,40(1):100-104.
[6]O'Donnell D,Furniss SS,Dunuville A,et al.Delayed cure despite early recurrence after pulmonary vein isolation for atrial fibrillation[J].Am J Cardiology,2003,91(1):83-85.
[7]Lee SH,Tai CT,Hsieh MH,et al.Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation[J].Interv Card Electrophysiol,2004,10(3):221-226.
[8]Jiang H,Lu Z,Lei H,et al.Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease[J].Interv Card Electrophysiol,2006,15(3):157-163.
[9]Berkowitsch A,Greiss H,Vukajlovic D,et al.Usefulness of atrial fibrillation burden as a predictor for success of pulmonary vein isolation[J].Pac Clin Electrophysiol,2005,28(12):1292-1301.
[10]Berruezo A,Tamborero D,Mont L,et al.Pre-procedural predictors of atrial fibrillation recurrence after circumferntial pulmonary vein ablation[J].Eur Heart J,2007,28(7):836-841.
[11]Wachtell K,Lehto M,Gerdts E,et al.AngiotensinⅡreceptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenoiol:the Losartan Intervention For End Piont Reduction in Hypertensiong(LIFE)Study[J].J Am Coll Cardiol,2005,45(5):712-719.
[12]Oral H,Knight BP,Tada H,et al.Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation[J].Circulation,2002,105(9):1077-1081.
[13]Haissaguerre M,Jais P,Shah DC,et al.Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers[J].Card Electrophysiol,2000,11(1):2-10.
[14]Jalife J,Kaur K.Atrial remodeling,fibrosis,and atrial fibrillation[J].Trend Cardiovascul Med,2015,25(6):475-484
[15]Hsu NW,Lin YJ,Tai CT,et al.Frequency analysis of the fibrillatory activity from surface ECG lead V1 and intracardiac recordings:implications for mapping of AF[J].Europace,2008,10(4):438-443.
[16]Maura M,Johannes B,Thorsten L,et al.Sex-related outcome of atrial fibrillation ablation:insights from the German ablation registry[J].Heart Rhythm,2016,13(9):1837-1844.
[17]Dimipi P,Prasant M,Luigi D,et al.Outcomes and complications of catheter ablation for atrial fibrillation in females[J].Heart Rhythm,2010,7(2)167-172.
[18]Jannik LP,Gunnar HG,Jim H,et al.Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014:a nationwide Danish cohort study[J].Eur Heart J,2018,39(6):442-449.
[19]Friberg L,Tabrizi F,Englund A,et al.Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death:data from Swedish health registries[J].Eur Heart J,2016,37(31):2478-2487.