长程持续性房颤与上腔静脉的关系研究  

Relationship between long-standing persistent atrial fibrillation and superior vena cava

作　　者：张道良[1] 徐楷[1] 王泽呈 姜伟峰[1] 邹广琛 吴绍辉[1] 刘旭[1] ZHANG Daoliang;XU Kai;WANG Zecheng;JIANG Weifeng;ZOU Guangchen;WU Shaohui;LIU Xu(Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai200030,China)

机构地区：[1]上海交通大学附属胸科医院心内科

出　　处：《国际心血管病杂志》2019年第5期301-304,共4页International Journal of Cardiovascular Disease

基　　金：上海市卫生和计划生育委员会中医药科研课题(2018JP009)

摘　　要：目的:探讨长程持续性心房颤动(房颤)与上腔静脉的关系。方法:连续入选210例长程持续性房颤患者,均行射频消融术。在术中通过标测导管评估与房颤维持相关的上腔静脉的情况。结果:仅2例(0.95%)患者长程持续性房颤被证实与上腔静脉有关。至术后12个月随访结束时,126例(60.00%)患者维持窦性心律,其中112例患者不使用抗心律失常药物。房颤复发组患者右心房扩大的比例较高(65.48%对48.41%,P=0.02),房颤持续时间更长[(75.12±46.42)个月对(44.30±34.82)个月,P<0.05],左心房内径更大[(49.20±5.97)mm对(45.04±5.31)mm,P<0.05)]。Logistic回归分析显示,左心房内径和房颤持续时间是房颤复发的危险因素。结论:长程持续性房颤患者射频消融术中很少检测到房颤与上腔静脉有关,行射频消融术时没有必要行经验性的上腔静脉电隔离。Objective:To investigate the relationship between superior vena cava(SVC)and atrial fibrillation in patients with long-standing persistent atrial fibrillation(AF).Methods:A total of 210 consecutive patients with long-standing persistent AF were enrolled.All the patients underwent radiofrequency ablation.SVC-triggered AF and the situation of SVC associated with maintenance of AF were evaluated by mapping catheters during the procedure.Results:The arrhythmogenic effect of SVC was confirmed in only two cases(0.95%).At 12 months follow-up,sinus rhythm was maintained in 126(60.0%)patients,among which 112 did not use antiarrhythmic drugs.The patients in AF recurrence group had higher ratio of right atrium enlargement(65.48%vs.48.41%,P=0.02),longer AF duration(75.12±46.42 months vs.44.30±34.82 months,P<0.05)and larger left atrium diameter(49.20±5.97 mm vs.45.04±5.31 mm,P<0.05).Logistic regression analysis showed that left atrium diameter and AF duration were independent risk factors of AF recurrence.Conclusions:The SVC is rarely detected as a trigger of long-standing persistent AF during radiofrequency ablation.It is unnecessary to conduct empirical electrical isolation of SCA during radiofrequency ablation.

关 键 词：心房颤动 上腔静脉 导管消融 

分 类 号：R54[医药卫生—心血管疾病]