瓣膜病合并房颤患者射频消融术后复发的危险因素  

Risk factors of recurrence of valvular atrial fibrillation after surgical radiofrequency ablation

作　　者：于明港 曹海龙[1] 李庆国[1] 周庆[1] 钱海荣[2] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,210008 [2]江苏省如皋人民医院胸外科

出　　处：《中华胸心血管外科杂志》2014年第4期210-212,217,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金（81200133）;南京市医学科技发展项目（YKK12077）

摘　　要：目的 探讨心脏瓣膜病手术患者同期行房颤外科射频消融术后房颤复发的危险因素.方法 回顾性分析2010年4月至2012年12月施行瓣膜手术同期行房颤射频消融治疗的255例瓣膜病合并房颤患者,多元回归分析筛选影响房颤复发的独立危险因素.结果 术后死亡8例,交界性心律或安装起搏器11例,失访60例,完成随访176例.术后长期心律监测结果示107例患者维持稳定的窦性心律,69例房颤复发.术前较大左心房内径、较高血清B型钠尿肽（BNP）、较慢心率和术后出院前出现房颤心律是术后房颤复发的独立危险因素.结论 术后4～ 38个月,平均12个月时,瓣膜病合并房颤患者射频消融治疗效果受术前左心房内径、BNP水平和心率影响;术后出院前出现房颤心律提示预后较差,应予药物或电复律干预.Objective The purpose of this study was to explore the risk factors of recurrence of atrial fibrillation （AF） after surgical radiofrequency ablation in patients undergoing cardiac valve surgery.Metbods Retrospective analysis was made in 255 cardiac valve patients undergoing concomitant radiofrequency modified Maze operation from April 2010 to December 2012 in Nanjing Drum Tower Hospital.Multivariate logistic regression analysis was used to screen independent risk factors for predicting recurrence of AF.Results Excluding 8 patients died after surgery,11 cases who were junctional rhythm after ablation or received pacemaker implantation and 60 lost case,176 patients were finished follow-up.107 cases maintained stable sinus rhythm （SR）,whereas other 69 cases developed AF recurrence.Multivariate logistic regression analysis found larger left atrial size,higher B-type natriuretic peptide,lower preoperative heart rate and postoperative AF rhythm before discharge were independent risk factors for predicting AF recurrence.Conclusion Larger left atrial size,higher B-type natriuretic peptide and lower preoperative heart rate before surgery can impact outcome of surgical radiofrequency ablation in patients undergoing cardiac valve surgery after following 12（4-38）months.They can be used in clinical practice to choose more suitable cardiac valve patients with AF for surgical ablation.Postoperative appearance of AF rhythm before discharge indicated a poor prognosis,which should be interfered with drugs or electrical cardioversion.

关 键 词：心房颤动 心脏瓣膜疾病 导管消融术 复发 危险因素 

分 类 号：R654.2[医药卫生—外科学]