心脏再同步治疗术后新发心房颤动与窦性心律的对比分析  

Comparison of the outcome between patients with new-onset atrial fibrillation and patients retained sinus rhythm after cardiac resynchronization therapy

作　　者：田芸[1] 王冬梅[1] 周薇薇[2] 臧红云[1] 于海波[1] 张东红[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心内科,110840 [2]沈阳军区总医院超声科,110840

出　　处：《中华心律失常学杂志》2010年第6期438-442,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：基金项目：中国人民解放军“十一五”课题（06MB049）

摘　　要：目的 分析心脏再同步治疗（CRT）术后1年内慢性心力衰竭（CHF）患者出现新发心房颤动（房颤）与保持窦性心律的疗效对比情况.方法 接受CRT治疗CHF患者54例,所有患者术前均无房颤病史,于术前和术后6、12个月进行程控随访及临床、超声心动图检查.结果 1年随访结束时,54例患者中有12例（22.2%）出现新发房颤,其余42例保持窦性心律.窦性心律组术后临床及超声心动图指标均较术前明显改善（P＜0.001）.新发房颤组术后心功能、左心室射血分数（LVEF）、左心室舒张末内径也较术前有明显改善（P＜0.05）,但左心房内径及二尖瓣反流无明显变化.两组间比较,左心房内径在窦性心律组较新发房颤组有明显缩小的趋势（P=0.057）.亚组分析,阵发性房颤患者术后心功能、LVEF较术前改善（P＜0.05）,而持续性房颤患者术后各指标较术前均无明显变化.CRT术后新发房颤危险因素经Logistic回归显示为术前二尖瓣反流程度（P=0.046,OR=3.729）和新发房颤发生前的心房起搏比例（P=0.010,OR=1.050）.结论 CRT术后新发房颤与二尖瓣反流程度加重和心房起搏比例增高明显相关.新发阵发性房颤一般不影响CRT疗效,新发持续性房颤CRT术后疗效较差.Objective To evaluate the effect of cardiac resynchronization therapy （CRT）in chronic congestive heart failure（CHF） patients who developed new-onset atrial fibrillation（AF） during one year followup after CRT,compared with those patients who retained sinus rhythm （SR）. Methods The study population consisted of 54 consecutive patients（42 men and 12 women age 60. 2 ± 11.4 years）who had an indication for CRT with no history of AF. New-onset AF was defined as atrial high-rate episodes 〉 180 bpm for more than 10minutes as detected by the device, or as any AF documented on an electrocardiogram or Holter monitoring during follow-up. Patients were assigned to the AF group and to sinus rhythm（SR） group. Clinical and echocardiographic（Echo） evaluation was performed at baseline、 after 6 months and 12 months of biventricular pacing. Results 12（22. 2% ）patients developed new-onset AF during one year follow-up. In the SR group,both the clinical and Echo indicators improved significantly after CRT（ P 〈 0. 001 ）. And in the AF group, there was also a significant improvement in NYHA functional class and left-ventricular（ LV ）ejection fraction during oneyear follow-up（ P 〈 0. 001 ）, as well as a reduction in LV end-diastolic diameter（ P = 0. 017 ） and a raised trend in 6-min walk test（ P = 0. 078 ）. But there was no changes about the left-atrial（LA） diameter and mitral regurgitation （MR）. When compared to the SR group, patients in AF group showed a trend of less LA reverse remodeling（ △LA, -0. 1 ±5.3 mm vs. -3. 2 ±5.3 mm,P =0. 057）. In logistic regression analysis,MR at baseline （P =0. 046 ,OR =3. 729,95% CI 1.021-13. 613） and the percentage of atrail pacing（AP% ） before AF occurrence were the independent predictors of new-onset AF after CRT（ P = 0. 010, OR = 1. 050,95% CI 1. 012-1.089）. Conclusion Patients with new-onset persistent AF had unfavorable outcomes after CRT. The severe MR and high AP% were the independent predictors of new-onset AF

关 键 词：心脏再同步治疗 术后新发心房颤动 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]