心房颤动患者行房室结消融并植入起搏器治疗后猝死的发生及其因素分析  

Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation

作　　者：李嘉萍[1] 王如兴[1] 郁志明[1] 张常莹[1] 高运来[1] 李库林[1] 郑杰[1] Shen Win-kuang 

机构地区：[1]南京医科大学附属无锡市人民医院心内科,江苏无锡214023 [2]Division of Cardiovascular Diseases,Department of Internal Medicine,Mayo Clinic

出　　处：《中国心脏起搏与心电生理杂志》2015年第2期112-116,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨心房颤动(简称房颤)患者行房室结消融并植入起搏器治疗后猝死的发生及其因素。方法患者为2005年至2009年美国Mayo Clinic医院517例行房室结消融并植入心脏永久起搏器的房颤患者,根据术后患者猝死的发生情况,分为猝死组和非猝死组,采用Cox比例风险回归模型分析比较两组总死亡率危险因素和猝死相关危险因素。结果 517例患者在(25.8±18.6)个月(3天至63.8个月)随访期间中有53例患者发生死亡,其中15例患者发生猝死。Cox比例风险回归模型分析表明心力衰竭、心功能分级、慢性肾功能不全和非持续性室性心动过速是预测患者总死亡率的危险因素,而扩张型心肌病和二尖瓣狭窄是预测患者猝死的危险因素,且猝死仅发生在消融前窄QRS波或右束支传导阻滞患者,而消融前完全性左束支传导阻滞患者不发生猝死。结论扩张型心肌病、二尖瓣狭窄和术前基础QRS波形态可能是预测房室结消融并植入起搏器治疗后患者发生猝死的重要危险因素。Objective To investigate sudden death and its risk factors after atrioventricular junction （AVJ） ablation and pacemaker implantation in patients with atrial fibrillation（AF）. Methods Five hundred and sevevteen AF patients with AVJ ablation and pacemaker implantation were enrolled in this study from January 2005 to December 2009 at Mayo Clinic of America. Patients were divided into sudden death group and non-sudden death group. Cox proportional hazards models were used to assess potential risk factors for overall mortality and sudden death. Results Fifty-three patients died and 15 with sudden death during follow up of （25.8＋18.6） months （range 3 days to 63.8 months）. Cox proportional hazard models showed that the presence of congestive heart failure, NYHA functional class, chronic renal failure, and non-sustained ven- tricular tachycardia were risk factors that predicted overall mortality. For sudden death, the presence of dilated cardiomyop- athy and mitral stenosis were the risk factors. Sudden death was almost exclusively found in patients who had narrow QRS complex or right bundle branch block prior to AVJ ablation and pacemaker implantation, and didn＇t occur in any patient with preexisting complete left bundle branch block. Conclusions Dilated cardiomyopathy, mitral stenosis and baseline QRS morphology should be examined as a potential risk factor for sudden death after AVJ ablation and pacemaker implantation.

关 键 词：电生理学 QRS形态 心房颤动 导管消融 心脏起搏 猝死 

分 类 号：R541.75[医药卫生—心血管疾病] R318.11[医药卫生—内科学]