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心电指标的预测  

Depolarization and repolarization parameters on ECG predict recurrence after atrial fibrillation ablation in patients with hypertrophic cardiomyopathy

作　　者：闻松男[1] 朱浩杰 邓家龙 刘念[1] 白融[1] 阮燕菲[1] 汤日波[1] 宁曼[1] 蒋晨曦[1] 桑才华[1] 龙德勇[1] 喻荣辉[1] 李松南[1] 杜昕[1] 黄建增 马长生[1] WEN Songnan;DEND Jialong;ZHU Haojie;LIU Nian;BAI Rong;RUAN Yanfei;TANG Ribo;NING Man;JIANG Chenxi;SANG Caihua;LONG Deyong;YU Ron-ghui;LI Songnan;DU Xin;DONG Jianzeng;MA Changsheng(Department of Cardiology,Beijing Anzhen Hospi-tal,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》2020年第1期1-5,18,共6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(81500254,81870243,81470464,81530016,81370290);北京市优秀人才培养计划(2015000021469G195)。

摘　　要：目的:探讨心电指标f QRS与QTc联合是否能更好预测肥厚型心肌病(HCM)合并心房颤动患者导管消融术后的复发。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120例(阵发/持续性心房颤动72/48)。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,f QRS定义为常规12导联心电图中至少两个连续导联的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。采用Bazett公式校正QT间期。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>30 s的房性快速性心律失常。结果:59.2%(71/120)患者f QRR阳性。f QRS最常见于下壁导联(81.7%)。QTc间期(443.90±38.59)ms。平均随访13.4个月,窦性心律维持率为42.5%。多因素Cox回归分析表明,f QRS阳性(HR=1.922,95%CI:1.151~3.210,P=0.012)和QTc>448 ms(HR=1.982,95%CI 1.155~3.402,P=0.013)分别是术后复发的危险因素。f QRS和QTc联合能更好预测心房颤动术后复发。结论:f QRS和QTc延长是HCM合并心房颤动患者导管消融术后复发的独立预测因素。f QRS和QTc联合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 f QRS or QTc is associated with arrhythmia recurrence after catheter ablation of AF in HCM patients.Methods:We enrolled 120 HCM patients who underwent primary AF ablation(48 with persistent AF).Pre-procedural QTc was measured and corrected using Bazett’s formula,and the distribution of f QRS was recorded.Arrhythmia recurrence was defined as any kind of documented atrial tachyarrhythmia of>30 s.Results:Arrhythmia recurrence occurred in 69 patients after 13.4 months’follow-up.f QRS was present in 71(59.2%)patients and was most commonly(81.7%)observed in the inferior leads.QTc>448 ms could predict arrhythmia recurrence with a sensitivity of 68.1%and specificity of 68.6%.Patients with QTc>448 ms(HR=1.982,95%CI:1.155-3.402,P=0.013)or those with f QRS+(HR=1.922,95%CI:1.151-3.210,P=0.012)were at an increased risk of recurrence.A combination of f QRS+and QTc>448 ms was superior to f QRS or QTc alone in predicting arrhythmia recurrence.Conclusions:In patients with HCM undergoing AF ablation,QTc prolongation,specifically>448 ms,and presence of f QRS are independent risk factors for arrhythmia recurrence at follow-up.The combination of these two parameters has greater predictive value and would help to identify patients who are at the highest risk of procedural failure.

关 键 词：肥厚型心肌病 心房颤动 碎裂QRS波 QTC间期 导管消融 

分 类 号：R54[医药卫生—心血管疾病]