心房颤动导管消融术后抗心律失常药物与复发的关系  

Antiarrhythmic drugs therapy and the risk of recurrence of atrial fibrillation after catheter ablation

作　　者：汤日波[1] 马长生[1] 董建增[1] 刘兴鹏[1] 龙德勇[1] 喻荣辉[1] 康俊萍[1] 史力生[1] 田颖[1] 郑斌[1] 何华[1] 陶海龙[1] 刘小慧[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科房颤中心,北京100029

出　　处：《中国心脏起搏与心电生理杂志》2009年第3期222-225,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助项目(项目编号:30670843;30500202;30570724);十一五国家高技术研究发展计划("863计划";2006AA02Z4E4)

摘　　要：目的探讨抗心律失常药物对心房颤动(简称房颤)导管消融术后早期复发和晚期复发的影响。方法210例房颤患者在三维电解剖标测系统和肺静脉环状标测电极联合指导下行环肺静脉电隔离。术后应用抗心律失常药物3个月,其中服用普罗帕酮29例、胺碘酮113例、索他洛尔3例,未服用药物65例,因索他洛尔组病例数少仅对前三组进行分析。早期复发定义为导管消融3个月内发生快速性房性心律失常,晚期复发定义为导管消融3个月后停用抗心律失常药物后发生快速性房性心律失常。结果三组平均年龄具有显著差异,余基线资料无显著性差异。术后3个月内共88例(41.9%)出现早期复发,普罗帕酮、胺碘酮、未服用抗心律失常药物三组早期复发率分别为41.4%,32.7%,55.4%,具有显著差异(P=0.013)。Logistic分析显示胺碘酮与早期复发独立相关(比数比=0.37,95%可信区间0.19～0.72,P=0.003)。随访180±75(91～374)天,66例(31.4%)晚期复发,三组晚期复发率分别为34.5%,28.3%,32.3%,无显著差异(P=0.752)。Logistic分析显示抗心律失常药物不是晚期复发的独立危险因素(P=0.978)。服索他洛尔3例均出现早期复发和晚期复发。结论术后服用抗心律失常药物特别是胺碘酮可显著降低房颤导管消融的早期复发,但对晚期复发无影响。Objective This study sought to investigate the impact of antiarrhythmic drugs on the recurrence of atrial fibrillation（AF） after catheter ablation. Methods Two hundred and ten consecutive patients with AF underwent circumferential pulmonary vein ablation guided by 3-D mapping system and Lasso were enrolled. After the procedure, 29 patients took propafenone, 3 patients took sotalol, 113 patients took amiodarone and the others did not take any antiarrhythmie drugs for the sake of contraindication or intolerence. The sample of sotalol group was so small that the patients with sotalol were not analyzed. Early recurrence was defined as atrial tachyarrhythmia within three months after the procedure. Late recurrence was defined as atrial tachyarrhythmia beyond three months after the procedure. Results Except the age, the baseline characteristics did not differ among the three groups. After the procedure, 88 （41：9%） patients had early recurrence. The early recurrence rates were 41.4% ,32.7% ,55.4% in the propafenone group, amiodarone group and non-antiarrhythmic drugs group with statistic significance, respectively（P = 0.013 ）. Logistic analysis revealed that amiodarone was an independent factor of early recurrence （ odds ratio = 0.37, 95% confidence interval 0. 19 - 0.72, P = 0. 003 ）. After 180±75 （91 -374）days follow-up, 66 （31.4% ） patients suffered from late recurrence. The late recurrence rates were 34.5% , 28.3% ,32.3% in the above three groups without statistic significance, respectively （P=0. 752）. Logistic analysis showed that antiarrhythmic drugs had no impact on the long-term outcome（P =0.978）. The patients with sotalol had both early recurrence and late recurrence. Conclusion Antiarrhythmic drugs therapy, especially amiodaorne, has great impact on the early recurrence, but not late recurrence after catheter ablation of AF.

关 键 词：心血管病学 心房颤动 导管消融 复发 抗心律失常药物 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]