中老年继发孔型房间隔缺损经导管封堵治疗前后房性快速性心律失常情况分析  

Prevalence and risk factors of atrial tachyarrhythmia before and after percutaneous closure of secundum atrial septal defect in patients over 40 years of age

作　　者：王诚[1] 赵世华[1] 蒋世良[1] 黄连军[1] 徐仲英[1] 凌坚[1] 郑宏[1] 张戈军[1] 闫朝武[1] 戴汝平[1] 

机构地区：[1]中国医学科学院 北京协和医学院 阜外心血管病医院放射科

出　　处：《中华心血管病杂志》2007年第9期797-801,共5页Chinese Journal of Cardiology

摘　　要：目的分析经导管封堵治疗中老年继发孔型房间隔缺损(ASD)术前、术后房性快速性心律失常(atrial tachyarrhythmia,AT)情况,并探讨术后发生 AT 的危险因素。方法回顾性分析经导管封堵治疗的连续264例中老年 ASD 患者的 AT 情况,并对介入治疗术前多个指标进行单因素分析和 logistic 回归分析。结果封堵术前总的 AT 发生率为9.1%(24/264例),其中40～49岁、50～59岁、≥60岁组术前 AT 发生率分别为4.3%、14.6%和26.3%,差异有统计学意义(P<0.01)。术后总的 AT 发生率为11.0%(29/264例),与术前相比,差异无统计学意义(P>0.05)。术后发生 AT 的29例中14例术前无 AT 病史。单因素分析结果显示,发生和未发生 AT 组在年龄、术前 AT 病史、高血压、三尖瓣反流、房间隔总长度、右室舒张末期内径、左房前后径、经食管超声缺损最大径和选用封堵器直径等方面差异有统计学意义。而 logistic 多因素回归分析结果显示,年龄(OR 值2.659,95%可信区间1.080～6.547,P<0.05)、术前 AT 病史(OR 值54.311,95%可信区间9.819～300.395,P<0.01)和左房增大(OR 值8.529,95%可信区间2.162～33.643,P<0.01)是术后出现 AT 的独立危险因素。结论中老年继发孔型 ASD 经导管封堵治疗前后 AT 发生率无显著性变化。年龄、术前 AT病史和左心房扩大为术后发生 AT 的独立危险因素。Objective In this study, we attempted to observe the prevalence and risk facors of atrial tachyarrhythmias （AT） before and after transcatheter closure of atrial septal defect （ASD）. Methods 264 adult patients aged over 40 years （67 men and 197 women） who underwent transcatheter closure of ASD between September, 1997 and December, 2005 were included in this study. Incidence of preoperative and postoperative AT was analyzed, risk factors for AT were determined with multivariate stepwise logistic regression analysis. Results Incidence of AT before closure was 9. 1% （24/264）. Twenty-nine patients （11.0 percent） developed AT after transcatheter closure （24 atrial fibrillation, 1 paroxysmal flutter, 4 paroxysmal atrial arrhythmia）. The prevalence in patients of 40 to 49 years, 50 to 59 years and above 60 years was 4. 3%, 14. 6% and 26. 3%, respectively. Most patients with atrial fibrillation were symptomatic. Compared to patients without AT, patients developed AT after closure were significantly older （ 53.0 ± 7.6 years vs. 47.8 ± 6. 6 years, P 〈 0. 01 ） and had larger defects （23.5 ± 5.7 mm vs. 21.3 ± 5.2 mm, P 〉 0. 05 ）, higher systolic pulmonary pressure （38.4 ± 13.1 vs. 34. 1 ± 10. 1, P 〈 0. 05 ） , larger left atrium dimension [（38.0±3.9） mmHg（1 mm Hg=0.133 kPa） vs. （33.6±4.4） mm Hg, P〈0.01], larger end diastolic right ventricular dimension [ （ 34. 7 ± 5.9 ） mm vs. ＇（ 32. 1 ± 6. 8 ） mm, P 〉 0. 05 ], higher incidence of tricuspid regurgitation （96. 6% vs. 75.3% , P = 0. 01 ） , higher incidence of preoperative AT （51.7% vs. 3. 8% , P〈0. 01 ） and higher incidence of hypertension （27. 6% vs. 10. 2%, P =0. 013）. Multivariate analysis showed that older age [ odds ratio （OR） 2. 659, 95 percent confidence interval （CI） 1. 080 to 6. 547, P 〈 0. 05 ], presence of preoperative AT （ OR 54. 311, CI 9. 819 to 300. 395, P 〈 0. 01 ）, and left atrial enlargement （ OR 8. 529 per 10 mm increment, Cl 2. 162 to 33. 643, P 〈

关 键 词：房间隔缺损 心律失常 导管封堵术 中老年 

分 类 号：R541.7[医药卫生—心血管疾病]