心房颤动患者行射频消融术后复发多因素分析
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摘要
目的探讨除左房前后径因素外,影响心房颤动患者行射频消融术后复发的其它相关危险因素。方法筛选于潍坊市人民医院心内一科行射频消融治疗的房颤患者中左房前后径<40mm的部分患者,根据术后随访情况,将该部分患者分为射频消融术后的复发组与未复发组,比较两组间相关资料差异,并将结果纳入多因素二分类logistic回归分析,筛选影响房颤复发的独立影响因素。结果行射频消融术3个月后复发房颤患者共20例,为复发组。余71例患者手术3个月后未复发房颤,为未复发组。比较两组患者的临床资料,其中,术后早期复发、房颤类型、NT-proBNP、BMI值,两组间差异有统计学意义(P<0.05),纳入多因素logistic回归分析,提示术后早期复发及持续性房颤为房颤射频消融术后复发的独立影响因素。结论持续性房颤患者及房颤消融术后早期复发为房颤术后复发的独立影响因素,术前判断患者房颤类型及术后早期的随访对预测患者术后复发可能性具有重要临床意义。
Objective To explore other related risk factors affecting recurrence of patients with atrial fibrillation besides the anterior and posterior dimensions of the left atrium.Methods Patients with atrial fibrillation whose anterior and posterior dimensions of the left atrium were less than 40 mm in Weifang People's Hospital were selected,and analyzed the relevant medical records retrospectively.According to the follow-up after radiofrequency ablation,the patients were divided into the recurrence group and the non-recurrence group and compare the differences between the two groups and incorporate the comparison results into multiple factors.Results Among them,20 patients with recurrent AF after 3 months of radiofrequency ablation were performed,it's the recurrence group.Patients had no recurrence of atrial fibrillation after 3 months of surgery,it's the non-recurrence group.The clinical data were compared between the two groups.Among them,early postoperative recurrence,type of atrial fibrillation,NT-proBNP,BMI,the difference between the two groups was statistically significant(P<0.05),including multivariate logistic regression analysis,suggesting that early recurrence and persistent atrial fibrillation are independent influencing factors of recurrence after radiofrequency ablation of atrial fibrillation.Conclusion Patients with persistent atrial fibrillation and early recurrence after AF ablation were independent factors of postoperative recurrence of AF.The preoperative diagnosis of atrial fibrillation and the early postoperative follow-up are predictive of the possibility of postoperative recurrence.Important clinical significance.
Objective To explore other related risk factors affecting recurrence of patients with atrial fibrillation besides the anterior and posterior dimensions of the left atrium.Methods Patients with atrial fibrillation whose anterior and posterior dimensions of the left atrium were less than 40 mm in Weifang People's Hospital were selected,and analyzed the relevant medical records retrospectively.According to the follow-up after radiofrequency ablation,the patients were divided into the recurrence group and the non-recurrence group and compare the differences between the two groups and incorporate the comparison results into multiple factors.Results Among them,20 patients with recurrent AF after 3 months of radiofrequency ablation were performed,it's the recurrence group.Patients had no recurrence of atrial fibrillation after 3 months of surgery,it's the non-recurrence group.The clinical data were compared between the two groups.Among them,early postoperative recurrence,type of atrial fibrillation,NT-proBNP,BMI,the difference between the two groups was statistically significant(P<0.05),including multivariate logistic regression analysis,suggesting that early recurrence and persistent atrial fibrillation are independent influencing factors of recurrence after radiofrequency ablation of atrial fibrillation.Conclusion Patients with persistent atrial fibrillation and early recurrence after AF ablation were independent factors of postoperative recurrence of AF.The preoperative diagnosis of atrial fibrillation and the early postoperative follow-up are predictive of the possibility of postoperative recurrence.Important clinical significance.
引文
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[2] den DW,Delgado V,Bertini M,et al.Impact of left atrial fibrosis and left atrial size on the outcome of catheter ablation for atrial fibrillation[J].Heart,2011,97(22):1847～1851.
[3] Pellman J,Lyon RC,Sheikh F.Extracellular matrix remodeling in atrial fibrosis:mechanisms and implications in atrial fibrillation[J].J Mol Cell Cardiol,2010,48(3):461～467.
[4] Wei W,Ge JB,Zou Y,et al.Anatomical characteristics of pulmonary veins for the prediction of postoperative recurrence after radiofrequency catheter ablation of atrial fibrillation[J].PLoS One,2014,9(4):e93817.
[5] 陈雄彪,方丕华,张澍,等.孤立性心房颤动的诊断在射频导管消融治疗效果评价中的作用[J].中国循环杂志,2014,29(增):134～135.
[6] 王显,李红梅.房颤射频消融术后复发相关危险因素及无创评估预测价值[J].中国循证心血管医学杂志,2016,8(2):129～130.
[7] Andrade JG,Khairy P,Verma A,et al.Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation[J].Pacing Clin Electrophysiol,2012,35:106～116.
[8] 孙源君,常栋,高连君.心房颤动患者射频导管消融后空白期复发机制及处理[J].中国循环杂志,2017,32(2):206～208.
[9] Rizos I,Tsiodras S,Rigopoulos AG,et al.Interleukin-2 serum levels variations in recent onset atrial fibrillation are related with cardioversion outcome[J].Cytokine,2007,40:157～164.
[10] Fujiki A,Sakamoto T,Nishida K,et al.Relation of interleukin-6 and creative protein levels to sinus maintenance after pharmacological cardioversion in persistent atrial fibrillation[J].J Cardiovasc Pharmacol,2007,50:264～266.
[11] 黄欣森,曲秀芬.心房颤动与自主神经的相关性研究进展[J].中国循环杂志,2015,30(10):1027～1029.
[12] 薛利,蔡衡.心房纤颤患者射频消融术后复发的相关因素分析[J].中国循证心血管医学杂志,2016,8(4):461～463.