二尖瓣置换术同期射频消融治疗持续性房颤的远期疗效及复发因素分析  

Long-term efficacy and related factors for recurrence of concurrent radiofrequency ablation during mitral valve replacement surgery in patients with persistent atrial fibrillation

作　　者：唐先成[1] 刘健[1] 黄击修 林小彬[1] 付建[1] TANG Xiancheng;LIU Jian;HUANG Jixiu;LIN Xiaobin;FU Jian(Department of cardiac Surgery,Jianyang People′s Hospital,Sichuan641400,China)

机构地区：[1]简阳市人民医院心血管外科,641400

出　　处：《国际心血管病杂志》2020年第6期375-379,共5页International Journal of Cardiovascular Disease

摘　　要：目的:观察二尖瓣置换术同期射频消融治疗持续性心房颤动(房颤)的远期疗效,分析术后远期复发因素。方法:回顾性分析2008年8月至2014年2月简阳市人民医院101例二尖瓣置换术同期射频消融治疗持续性房颤患者的临床资料。根据末次随访时的心电图结果将患者分为房颤消除组与房颤复发组。分析术后远期窦性心律维持率,探讨影响术后远期复发的因素。结果:在101例房颤患者中,2例于住院及随访期间死亡,5例失访,有效随访94例,随访时间为5~10年(中位数6.7年)。术后1~10年随访窦性维持率分别为:82.9%(78/94)、82.9%(78/94)、78.7%(74/94)、76.6%(72/94)、75.5%(71/94)、70.9%(44/62)、60.9%(25/41)、56.5%(13/23)、53.8%(7/13)、50.0%(3/6)。房颤消除组共68例,房颤复发组共26例,房颤消除组的年龄[(47.5±8.14)岁对(52.4±8.14)岁,P=0.01]、术前左房内径[(48.7±7.7)mm对(62.6±18.4)mm,P=0.001]、术前左室舒张末期容积[(91.5±37.0)mm对(114.6±35.3)mm,P=0.031]、术前右房内径[(47.3±10.1)mm对(56.1±13.2)mm,P=0.011]均明显小于房颤复发组。多因素分析结果表明,年龄及术前左房内径是影响患者术后远期房颤复发的独立危险因素。年龄>52.5岁及LA≥55.5 mm对术后远期复发的预测值较高,该类患者房颤术后远期复发率更高(P均<0.05)。结论:二尖瓣置换术中同期射频消融治疗持续性房颤远期疗效好,年龄及术前左房内径是术后远期房颤复发的独立危险因素。Objective:To observe the long-term efficacy and related factors for recurrence of radiofrequency ablation during mitral valve replacement in patients with persistent atrial fibrillation(AF).Methods:The clinical data of 101 patients with AF undergoing radiofrequency ablation during mitral valve replacement from August 2008 to February 2014 in Jianyang People′s Hospital were retrospectively analyzed.Patients were divided into AF elimination group and AF recurrence group according to the ECG results at the last follow-up.The sinus rhythm maintenance rate was calculated,and related factors for recurrence were analysed.Results:Among 101 patients,94 completed follow-up(two died during hospitalization and follow-up,five were lost to follow-up).Follow-up time was 5 to 10 years(the median number was 6.7 years).The sinus rhythm maintenance rate was 82.9%(78/94)at one year after surgery,82.9%(78/94)at two years,78.7%(74/94)at three years,76.6%(72/94)at four years,75.5%(71/94)at five years,70.9%(44/62)at six years,60.9%(25/41)at seven years,56.5%(13/23)at eight years,53.8%(7/13)at nine years,50.0%(3/6)at ten years,respectively.There were 68 cases in AF elimination group,with 16 males and 52 females.While there were 26 cases in AF recurrence group,including 9 males and 17 females.Univariate analysis showed that compared with the AF recurrence group,the age[(47.5±8.14)years vs.(52.4±8.14)years,P=0.01]and the preoperative left atrial diameter[(48.7±7.7)mm vs.(62.6±18.4)mm,P=0.001],preoperative left ventricular end-diastolic volume[(91.5±37.0)mm vs.(114.6±35.3)mm,P=0.031],and preoperative right atrium diameter[(47.3±10.1)mm vs.(56.1±13.2)mm,P=0.011]in AF elimination group were smaller.Multivariate analysis showed that age and preoperative left atrial diameter were independent risk factors for the long-term recurrence of AF.Age>52.5 years and left atrial diameter>55.5 mm had a higher predictive value for long-term recurrence,and patients who suffered no recurrence of AF with age>52.5 years and left atrial diameter>55.5

关 键 词：持续性房颤 外科消融 远期复发 危险因素 

分 类 号：R654.2[医药卫生—外科学]