QTc延长预测肥厚型心肌病合并心房颤动患者导管消融术后的复发  

Prolongation of QTc interval predicts atrial fibrillation recurrence after catheter ablation in patients with hypertrophic cardiomyopathy

作　　者：刘念[1] 闻松男[1] 桑才华[1] 汤日波[1] 龙德勇[1] 白融[1] 喻荣辉[1] 杜昕[1] 董建增[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2014年第3期315-319,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科委科技项目(D131100005313007);国家重点基础研究发展计划(2013CB531105)

摘　　要：目的：探讨肥厚型心肌病（hypertrophic cardiomyopathy,HCM）合并心房颤动患者的QTc是否与心房颤动导管射频消融术后复发相关.方法：回顾性分析2006年11月至2013年6月,在北京安贞医院第一次行导管射频消融术的HCM合并心房颤动患者共39例,收集术前心电图和其他临床资料,术后定期随访.结果：随访（14.8±11.7）个月,23例患者心房颤动消融术后复发（复发率59％）.与未复发组相比,复发组QTc显著性延长[（461±29） vs.（434±18） ms,P=0.001）].多因素Logistic回归分析显示QTc和左心房前后径（LAD）是心房颤动复发的独立危险因素.其中,当QTc截断值为448ms时,其预测心房颤动复发的敏感性为0.81,特异性为0.78.多因素Cox回归分析表明QTc每增加10ms,心房颤动复发的风险比为1.227 （95％ CI：1.053～1.431,P=0.009）.与LAD单独预测术后复发相比,LAD和QTc联合能更好地预测心房颤动消融术后复发.短QTc和左心房偏小的患者无心房颤动复发.结论：QTc延长能预测HCM合并心房颤动患者导管消融术后复发.短QTc和左心房偏小的患者导管消融术后复发率低.Objective： This study sought to determine whether prolongation of QTc interval predicts atri al fibrillation （AF） recurrence after catheter ablation in a cohort of patients with hypertrophic cardiomyopathy （HCM）. Methods：we retrospectively enrolled 39 HCM patients with atrial fibrillation who underwent the first time catheter ablation procedure in Beijing Anzhen hospital. Baseline data and QTc before procedure were collected. Results： 23 patients had AF recurrence after a mean follow-up of （ 14. 8 ± 11.7） months. Those experiencing recurrence had longer QTc than those who did not experience recurrence [ （461 ±29） vs. （434 ± 18） ms,P =0. 001 ）]. Multivariate logistic regression analysis demonstrated that QTc and left atrium dimension （LAD） were independent predictors for recurrence of AF. Using the cutff value of 448ms, QTc predicted the recurrence with sensitivity of 81% and specificity of 78%. Cox regression analysis showed that each 10ms increase in QTc was associated with an increased risk of AF recurrence （HR = 1. 227, 95% CI： 1. 053 ±1. 431 ,P = 0. 009）. QTc had an incremental value over LAD in predicting AF recurrence after catheter ablation. There was no recurrence in the patients with small LAD and short QTc. Conclusion： QTc is an independent predictor of AF recurrence in HCM patients with AF. HCM patients with short QTc and small LAD would have better outcome after catheter ablation.

关 键 词：肥厚型心肌病 心房颤动 导管消融 QTC间期 复发 

分 类 号：R54[医药卫生—心血管疾病]