甲状腺素替代治疗对老年心房颤动患者导管消融成功率的影响  

Effect of thyroxine replacement therapy with residual subclinical hypothyroidism on the success rate of catheter ablation in elderly patients with atrial fibrillation

作　　者：陈英伟[1] 郭炜华[2] 秦小飞[1] 桑才华[3] 龙德勇[3] 喻荣辉[3] 韩战营[1] 邱春光[1] 董建增[3] 马长生[3] 

机构地区：[1]郑州大学第一附属医院心内科,450052 [2]首都医科大学附属北京同仁医院心内科,100041 [3]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华老年医学杂志》2017年第7期735-738,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨甲状腺素替代治疗对合并甲状腺功减退的老年心房颤动（房颤）患者导管消融成功率的影响。方法前瞻性研究，连续入选2009-2012年在三家医院首次接受导管消融的房颤患者中，筛选出接受甲状腺素替代治疗的合并甲状腺功能低下的房颤的老年患者56例（研究组），其中41例阵发性房颤，15例持续性房颤；选择56例年龄、性别、房颤类型、左心房大小及体质指数等指标匹配的甲状腺功能正常的房颤患者为对照组，比较两组患者的随访结果。结果随访结束时，研究组和对照组首次手术窦性心律维持率分别为37．5％（21／56）和64．3％（36／56），差异有统计学意义（x2=8．655，P=0．003）；最后一次消融后两组患者窦性心律维持率分别为62．5％（35／56）和80．4％（45／56）（x2=4．653P=0．031）。两组间并发症风险比较差异无统计学意义（P=0．642）。结论对于合并甲状腺功能减退的老年房颤患者，甲状腺素替代治疗可降低导管消融成功率。Objective To investigate the effect of thyroxine replacement therapy with residual subclinical hypothyroidism on the success rate of catheter ablation in elderly patients with atrial fibrillation（AF）. Methods Among the consecutive patients with AF who underwent a first AF ablation in our center between 2009 and 2012, we identified 56 patients（41 paroxysmal AF, 15 persistent AF）with subclinical clinical hypothyroidism after receiving thyroid hormone replacement therapy as study group. The control group consisted of 56 patients with euthyroidism and no history of thyroid dysfunction. All patients underwent catheter ablation. Results At the end of follow up, 37.5%（21/56）patients were AF free after the first procedure in the study group, in comparison to 64.3%（36/56）in control group（x2 =8. 655,P=0. 003）. Last procedure was performed in 27 patients of study group and in 15 patients of control group. After the last performed ablation, 62.5 % （35/56） study group patients and 80.4% （45/55）controls group patients had no recurrence（z2= 4. 653,P= 0. 031）. The major complications rate did not differ between two groups（P=0. 642）. Conclusions Thyroid hormone replacement therapy with residual subclinical hypothyroidism reduces catheter ablation success rate in elderly patients with atrial fibrillation.

关 键 词：心房颤动 导管消融术 甲状腺疾病 

分 类 号：R541.75[医药卫生—心血管疾病]