持续性心房颤动消融后复发类型对再次消融的影响  

The impact of recurrent arrhythmia type after persistent atrial fibrillation ablation on the outcome of repeated ablation

作　　者：郭雪原[1] 龙德勇[1] 喻荣辉[1] 汤日波[1] 白融[1] 刘念[1] 桑才华[1] 蒋晨曦[1] 李松男 杜昕[1] 董建增[1] 马长生[1] GUO Xueyuan;LONG Deyong;YU Ronghui;TANG Ribo;BAI Rong;LIU Nian;SANG Caihua;JIANG Chenxi;LI Songnan;DU Xin;DONG Jianzeng;MA Changsheng(Department of Cardiology,Belting Anzhen Hospital,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7期604-607,613,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81700299)

摘　　要：目的:本研究旨在评价持续性心房颤动初次导管消融术后,复发不同心律失常类型对再次消融预后的影响。方法:连续入选持续性和长时程持续性心房颤动因初次消融后,复发接受第二次导管消融术的患者173例。初次消融策略为双侧肺静脉电隔离以及左心房顶部线、二尖瓣峡部线、三尖瓣峡部线的双向传导阻滞。根据术前心电图和病史特征以及术中电生理检查结果分为四组:复发持续性心房颤动组(Group 1,n=40),复发阵发性心房颤动组(Group 2,n=33),复发折返性房性心动过速组(Group 3,n=86),复发局灶性房性心动过速组(Group 4,n=14)。术后3、6、12个月和以后每6个月随访1次,评价无抗心律失常药物应用的情况下窦性心律的维持率。结果:基线资料分析发现,与其他三组患者相比Group 1患者左心房明显较大。初次消融术后有73.6%的患者至少1条肺静脉恢复传导,二尖瓣峡部线、三尖瓣峡部线和左心房顶部线恢复传导比例为68.8%、39.3%和50.9%。术中电生理检查结果显示,Group 3患者中47.7%的患者为二尖瓣峡部相关心房扑动。平均随访(26.6±8.8)月,104例患者(60.1%)无心律失常发作。复发组与未复发组差异无统计学意义。四组患者在未服用抗心律失常药物的情况下,窦性心律维持率分别为35.0%、57.6%、69.8%、78.6%(P=0.001)。结论:持续性心房颤动初次消融术后,复发心律失常以大折返性房性心动过速为主,复发折返或局灶房性心动过速患者再次消融后窦性心律维持率高。Objective： Patients with persistent and longstanding persistent atrial fibrillation（ AF） have a higher recurrence rate after catheter ablation. This study investigated the impact of the type of recurrent AF on the outcome of redo procedure in patients experiencing recurrence following persistent atrial fibrillation ablation.Methods： 173 patients who experienced recurrence after primary ablation of persistent AF were enrolled. According to the type of recurrent arrhythmia,patients were classified into persistent AF（ group 1,n = 40）,paroxysmal AF（ group 2,n = 33）,atrial flutter（ group 3,n = 86） and atrial tachycardia（ group 4,n = 14）. KaplanMeier estimation were used to estimate the relationship between recurrent AF type and the outcome of the second ablation. Ablation technique was identical in both procedures including isolation of ipsilateral PVs and blockage of LA roof line,mitral and tricuspid isthmus lines. Results： The diameter of left atrium were larger in patients in group 1（ 43. 8 ± 6. 3） mm. In the redo procedures,conduction recovery in at least one pulmonary vein was observed in 73. 6% patients. Conduction recovery rate across theM I,CTI and LA roofline were 68. 8%,39. 3% and 50. 9% respectively. During a mean follow-up of（ 26. 6 ± 8. 8） months,patients in group 3 and group 4 were more likely to maintain in sinus rhythm in the absence of antiarrhythic drugs therapy（ P =0. 001）. Conclusion： In patients presenting for a repeat procedure after ablation of persistent AF,atrial flutter was the most common arrhythmia type. Ablation the occurrence of atrial flutter and atrial tachycardia were associated with a significantly better outcome compared with recurrent paroxysmal and persistent AF.

关 键 词：心房颤动 射频消融术 复发 房性心动过速 

分 类 号：R54[医药卫生—心血管疾病]