房室旁道合并心房颤动的影响因素探析  

Analysis of influencing factors of atrioventricular accessory pathway in patients with atrial fibrillation

作　　者：张海涛[1] 韩丹[1] 代佰玲[1] 丛培欣[1] 洪丽[1] 林治湖[1] 

机构地区：[1]大连医科大学附属第一医院心血管检查科,辽宁大连116011

出　　处：《中国心脏起搏与心电生理杂志》2017年第6期533-536,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的总结分析房室旁道合并心房颤动(简称房颤)患者的临床、心电图及电生理特征,以探讨房室旁道合并房颤的影响因素。方法收集房室旁道合并房颤患者作为房颤组,另选单纯房室旁道而无房颤的患者作为对照组。根据旁道性质将房颤组分为显性组和隐性组,根据射频消融术后是否再发房颤将房颤组分为再发组和无再发组。分析并比较显性组与隐性组、房颤组与对照组、再发组与无再发组的临床、心电图及电生理特征。结果房颤组105例,行射频消融术73例;对照组109例。73例合并房颤的房室旁道患者,显性旁道62例(84.9%),隐匿性旁道11例(15.1%)。Logistic回归分析显示,年龄(OR=0.896,95%CI 0.861~0.934,P<0.001)、左房内径(OR=0.895,95%CI 0.830~0.966,P=0.004)、右侧旁道(OR=0.220,95%CI 0.085~0.569,P=0.002)是房室旁道患者发生房颤的独立易患因素。单纯消融旁道组与同时消融旁道和房颤组术后房颤再发率没有统计学差异(6.1%vs16.7%,P=0.208)。结论显性旁道患者更易合并房颤;年龄大、左房内径大、右侧旁道的房室旁道患者更易发生房颤;消融旁道的同时是否消融房颤,对术后房颤的再发没有影响。Objective To summarize and analyze the clinical,electrocardiographic and electrophysiologic characteristics of atrioventricular accessory pathway in patients with atrial fibrillation（AF）,and to explore the influence factors of atrioventricular accessory pathway in patients with AF. Methods Patients with merger of atrioventricular bypass and AF were chosen as AF group,while patients with simple atrioventricular bypass and without AF were chosen as control group.According to the nature of the bypass AF group was divided into explicit and implicit group,according to whether the recurrence of AF occurred after radiofrequency ablation,AF group was divided into recurrence group and no recurrence group.The clinical,electrocardiographic and electrophysiological characteristics were analyzed and compared between explicit and implicit group,between AF and control group,and between recurrence and no recurrence group. Results Among 73 patients of atrioventricular accessory pathway with AF,62 cases（84.9%）had dominant or intermittent accessory pathways,11 cases（15.1%）had concealed accessory pathways.Logistic regression analysis showed that age（OR= 0.896,95% CI 0.861-0.934,P0.001）,left atrial diameter（OR=0.895,95%CI 0.830-0.966,P=0.004）and right accessory pathways（OR= 0.220,95% CI 0.085-0.569,P =0.002）were the independent risk factors of AF in patients with atrioventricular accessory pathway.There was no statistical difference in recurrence rate of AF（6.1% vs 16.7%,P=0.208）between ablation of only accessory pathway and ablation of both accessory pathway and AF. Conclusion Patients with dominant accessory pathways are more likely to suffer from AF.Patients with older age,bigger left atrial diameter and right side accessory pathway are more liable to AF.Whether ablating AF during the proceture of accessory pathway ablation has no effect on the recurrence of AF.

关 键 词：心血管病学 房室旁路 心房颤动 射频消融 心电图 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]