碎裂QRS波预测肥厚型心肌病合并心房颤动患者射频消融术后心律失常复发的探讨  

Fragmented QRS predicts arrhythmia recurrence after catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy

作　　者：孙鹏瑜 常三帅 闻松男[1] 刘念[1] 白融[1] 汤日波[1] 宁曼[1] 吴佳慧[1] 阮燕菲[1] 蒋晨曦[1] 桑才华[1] 龙德勇[1] 喻荣辉[1] 李松南[1] 杜昕[1] 董建增[1] 马长生[1] SUN Pengyu;CHANG Sanshuai;WEN Songnan;LIU Nian;BAI Rong;TANG Ribo;NING Man;WU Jiahui;RUAN Yanfei;JIANG Chenxi;SANG Caihua;LONG Deyong;YU Rong- hui;LI Songnan;DU Xin;DONG Jianzeng;MA Changsheng(Department of Cardiology, Beijing Anzhen Hos- pital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2018年第4期298-302,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：重点研究计划(2016YFC0900901);北京市科委项目(D151100002215003);国家自然科学基金(81500254;81470464;81530016;81370290);北京市优秀人才培养计划(2015000021469G195)

摘　　要：目的:探讨碎裂QRS波(f QRS)与肥厚型心肌病(HCM)合并心房颤动患者导管消融术后的复发是否有关。方法:纳入在北京安贞医院行导管消融术的HCM合并心房颤动患者共91例(阵发/持续性心房颤动:60/31)。消融策略包括:阵发性心房颤动患者行双侧肺静脉隔离(PVI);持续性心房颤动患者行PVI加左心房顶、二尖瓣峡部和三尖瓣峡部线性消融。术前评估基线心电图,fQRS定义为常规12导联心电图中至少2个连续导联的QRS波存在≥2个R波或者R波的波顶或S波的波谷出现顿挫波。术后定期随访,复发定义为导管消融术后心电图或动态心电图记录的任何类型的>30s的房性快速性心律失常。结果 68.1%(62/91)患者fQRS阳性。fQRS最常见于下壁导联(75.8%)。平均随访18个月,窦性心律维持率为54.2%(59/91),74.6%(44/59)复发发生在1年以内。fQRS阳性组复发率高于fQRS阴性组(79.0%vs.34.5%,P<0.001)。多因素Cox回归分析表明,fQRS是术后快速房性心律失常复发的危险因素(HR=3.243,95%CI:1.147~9.167,P=0.026)。结论:fQRS是HCM合并心房颤动患者导管消融术后房性心律失常复发的预测因子,可用于预测该类患者心房颤动射频术后转归。Objective：This study is to investigate whether fQRS is associated with arrhythmia recurrence after catheter ablation of AF in hypertrophic cardiomyopathy（HCM）patients.Methods：91 HCM patients who underwent primary AF ablation at Beijing Anzhen hospital were enrolled.Ablation strategy included bilateral pulmonary vein isolation（PVI）for paroxysmal AF（n=60）and PVI plus left atrial roof,mitral isthmus and tricuspid isthmus linear ablations for persistent AF（n=31）.Baseline ECG was reviewed prior to index procedure and fQRS was defined as notching of the R or S wave in 2 contiguous ECG leads.Arrhythmia recurrence was defined as any kind of post-procedural atrial tachyarrhythmia of30s documented by ECG or Holter.Results：fQRS was present in 62（68.1%）patients at baseline.fQRS was most commonly observed in inferior lead（75.8%）.After an average of 18 months’follow-up,59 patients experienced arrhythmia recurrence with most recurrence（44/59,74.6%）occurred within 1 year.Arrhythmia recurrence rate in the fQRS（＋）group（79.0%,49/62）was higher than that in the fQRS（-）group（34.5%,10/29;P〈0.001）after single procedure.Multivariate COX regression demonstrated that fQRS was an independent risk factor of recurrence（HR=3.243,95%CI：1.147-9.167,P=0.026）.Conclusion：fQRS is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation,and could be useful for identifying those patients likely to have a better outcome following the procedure.

关 键 词：肥厚型心肌病 心房颤动 碎裂QRS波 导管消融 复发 左心房 

分 类 号：R54[医药卫生—心血管疾病]