导管消融与药物治疗对肥厚型心肌病合并心房颤动患者心血管原因住院率的影响  

The effect of catheter ablation and pharmacologic therapy on cardiac-related hospitalization in hypertrophic cardiomyopathy patients with atrial fibrillation

作　　者：李景业[1] 杜昕[1] 龙德勇[1] 蒋晨曦[1] 郭雪原[1] 张婷[1] 李新[1] 董建增[1] 马长生[1] LI Jing-ye DU Xin LONG De-yong JIANG Chen-xi GUO Xue-yuan ZHANG Ting LI Xin DONG Jian-zeng MA Chang-sheng(Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国介入心脏病学杂志》2016年第10期552-557,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81470464;81530016);北京市医院管理局临床医学发展专项经费资助(ZYLX201302);科技部国际合作项目(2013DFB30310)

摘　　要：目的探讨导管消融与药物治疗对肥厚型心肌病（hypertrophic cardiomyopathy,HCM）合并心房颤动（房颤）患者心血管原因住院率的影响。方法连续入选2004年6月至2015年3月于首都医科大学附属北京安贞医院等7家医院首次接受导管消融治疗的48例HCM合并房颤患者作为导管消融组,纳入同期仅接受药物治疗的78例HCM合并房颤患者作为药物治疗组。随访观察患者房颤复发及心血管原因住院情况。结果导管消融组48例患者均顺利完成房颤导管消融,单次术后平均随访（17.6±8.4）个月,16例（33.3%）复发房颤,32例（66.7%）维持窦性心律;药物治疗组平均随访（10.7±8.0）个月,31例（39.7%）转复为窦性心律;导管消融组患者窦性心律维持率显著高于药物治疗组,差异有统计学意义（P=0.003）。与药物治疗组相比,导管消融组的非计划性心血管原因住院率显著降低[2例（4.2%）比17例（21.8%）,P=0.001]。Cox多因素分析显示,房颤治疗策略（导管消融/药物治疗,HR 9.082,95%CI 1.130~73.011,P=0.038）和既往心力衰竭史（HR 2.860,95%CI 1.072~7.633,P=0.036）是非计划性心血管原因住院的独立危险因素。结论 HCM合并房颤组患者导管消融治疗的窦性心律维持率及非计划性心血管原因住院率均优于药物治疗组患者,房颤治疗策略和既往心力衰竭史是非计划性心血管原因住院的独立危险因素。Objective To evaluate the effect of radiofrequency catheter ablation（ RFCA） and pharmacologic therapy on cardiac-related hospitalization in hypertrophic cardiomyopathy（ HCM） patients with atrial fibrillation（ AF）. Methods This study enrolled forty-eight HCM patients with AF who initially underwent catheter ablation. Seventy-eight subjects who only received pharmacologic therapy were selected as the control group. AF recurrence and cardiac-related hospitalization were followed-up routinely.Results After follow-up of 17. 6 ± 8. 4 months,AF recurrence occurred in 16（ 33. 3%） patients after a single procedure. In the control group,successful restoration of sinus rhythm was achieved in 39. 7%patients after an average of 10. 7 ± 8. 0 months. The unplanned cardiac-related hospitalization rate was significantly lower in the RFCA group（ 21. 8% vs. 4. 2%,P = 0. 0013）. Cox regression analysis revealed that therapeutic strategy（ HR 9. 082,95% CI 1. 130- 73. 011,P = 0. 038） and heart failure history（ HR2. 860,95% CI 1. 072- 7. 633,P = 0. 036） were independent risk factors of unplanned cardiac-related hospitalization. Conclusions In HCM patients with AF, catheter ablation seems to be superior to pharmacologic therapy in sinus rhythm maintenance and unplanned cardiac-related hospitalization reduction.Therapeutic strategy and heart failure history were independent risk factors of unplanned cardiac-related hospitalization.

关 键 词：肥厚型心肌病 心房颤动 导管消融 药物 心血管原因住院 

分 类 号：R541[医药卫生—心血管疾病]