心脏外科手术及导管消融史对心房扑动发生机制的影响  

Effect of previous cardiac surgery for structural heart disease and radiofrequency catheter ablation on the mechanism of atrial flutter

作　　者：牛国栋[1] 林锦璇[1] 陈明龙[2] 苏晞 杨延宗[4] 夏云龙[4] 周贤慧[5] 刘启明[6] 马坚[1] 姚焰[1] 张澍[1] 

机构地区：[1]中国医学科学院 北京协和医学院 国家心血管病中心 心血管疾病国家重点实验室 阜外医院心律失常中心,100037 [2]南京医科大学附属第一医院心内科 [3]武汉亚洲心血管病医院 [4]大连医科大学附属第一医院 [5]新疆医科大学第一附属医院心内科 [6]中南大学湘雅二院心内科

出　　处：《中华心律失常学杂志》2017年第1期41-46,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家科技支撑计划（2011BAI11802）

摘　　要：目的 本文探讨既往心脏外科手术/导管消融史对心房扑动（房扑）发生机制及随后接受导管消融治疗成功率的影响.方法 本研究为前瞻性、多中心、开放性注册研究,数据来源于国家＂十二五＂科技支撑计划心律失常介入治疗的数据库平台,连续入选2013年1月至2015年12月于中国10个省份18家医院接受导管消融的房扑患者,根据既往是否接受导管消融及心外科手术,将患者分为对照组、射频组（房颤亚组、非房颤亚组）、手术组,分析其对房扑发生机制及本次导管消融治疗急性成功率的影响,及其他可能影响因素.结果 共入选401例房扑患者,对照组322例,射频组31例,手术组48例.根据房扑发生机制,左心房起源、右心房三尖瓣峡部（CTI）依赖、右心房非CTI依赖性房扑分别占9.0％、82.9％及8.1％.其中对照组、射频-非心房颤动（房颤）组、手术组均以CTI依赖性房扑为主,分别占91.3％、66.7％、64.6％,消融-房颤组以左心房起源房扑为主,占68.4％,差异具有统计学意义（P〈0.001）.对本次导管消融急性成功率而言,既往是否存在心脏相关手术/射频史的影响不具有统计学意义;分析提示对于CTI依赖性房扑患者,影响因素主要为心功能（99.3％、100％、83.3％,P〈0.001）;对于左心房房扑而言,左心房内径（LAD）〉45 mm是主要影响因素（100.0％对50.0％,P=0.010）.结论 ①心脏外科手术患者房扑发生机制仍以右心房峡部依赖性折返为主,但既往行房颤消融患者以左心房起源房扑为主.②既往心脏相关手术史对各型房扑急性成功率影响差异无统计学意义.Objective The present study aimed to analyze the effect of previous cardiac surgery（PCS）for structural heart disease or radiofrequency catheter ablation（ABL）on the mechanism of atrial flutter.Methods This was a prospective,multicenter,and open registry study.Data were collected from the database platform for interventional therapy of arrhythmia from the national center for cardiovascular diseases.Patients who underwent radiofrequency catheter ablation for AFL were consecutively enrolled from 18 hospitals in 10 provinces between January,2013 and December,2015,those with incomplete data were excluded.The patients＇ baseline clinical data,perioperative data were collected.According to previous history of catheter ablation or cardiac surgery,patients were divided into three groups,control group（n=322）,ABL group（n=31）and PCS group（n=48）.The composition of different mechanisms of AFL and the influencing factors of the success rate of present catheter ablation for AFL were analyzed.Results Four hundred and one patients who underwent radiofrequency catheter ablation for AFL were enrolled.Left atrium originating AFL,cavotricuspid-isthmus（CTI）dependent AFL and Right atrium non-CTI dependent AFL account for 9.0%,82.9%and 8.1%respectively.The majority of AFL mechanism still were typical AFL in control group,ABL-non-AF subgroup and PCS group（91.3%,66.7%and 64.6%）,whereas more left atrium originating AFL were found in ABL-AF subgroup（68.4%,P〈0.001）.There was no significant difference in AFL success rate among the three groups.As for typical AFL,success rate varied among different NYHA classifications（99.3%vs.100%vs.83.3%,P〈0.001）.For left atrium originating AFL,left atrium diameter was the major influencing factor（100.0%vs.50.0%,P=0.010）.Conclusion In patients with PCS or ABL,typical AFL still was the most common mechanism,However,history of PVAI（pulmonary vein antrum isolation）is associated with a higher proportion of left atrium originating AFL.Previous cardiac surgery and abl

关 键 词：心房扑动 心脏手术史 导管消融 注册研究 

分 类 号：R541.75[医药卫生—心血管疾病]