心房颤动患者射频消融术后心率变异性变化及房性早搏频度与预后的分析  

Relationship among changes of heart rate variability,frequency of atrial premature beats and prognosis in patients with atrial fibrillation after radiofrequency ablation

作　　者：赵小平[1] 朱正炎 曹冠红 刘小娟 刘燕 张建国 Zhao Xiaoping;Zhu Zhengyan;Cao Guanhong;Liu Xiaojuan;Liu Yan;Zhang Jianguo(Dynamic Electrocardiogram Monitoring Room,Shunyi District Hospital,Beijing 101300,China;不详)

机构地区：[1]北京市顺义区医院动态心电图室,北京101300 [2]北京市顺义区医院心内科,北京101300

出　　处：《中国循证心血管医学杂志》2021年第2期202-205,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨心房颤动(房颤)患者射频消融术后,心率变异性(HRV)值低于正常与复发的关系,频发房性早搏与复发的关系。方法回顾性分析2012年1月至2019年12月房颤射频消融术后于北京市顺义区医院行动态心电图检查的患者143例,其中男性71例,女性72例,平均年龄(59.90±11.12)岁。将术后1~5个月的患者归为早期,术后6个月~1年及1年后归为晚期,根据动态心电图结果,将术后早期房性早搏及短阵房性心动过速的频发或偶发分为复发组与未复发组;将术后早期窦性心搏RR间期标准差(SDNN)值正常或降低(SDNN<100 ms为降低,即SDNN值低于正常)分为复发组与未复发组;据术前是否合并器质性心脏病分为术后早期复发组与未复发组,观察统计动态心电图中房性早搏及短阵房速的次数;HRV指标中SDNN值;房颤和/或房扑发生阵次及持续时间;持续房速等,并进行比较分析。结果动态心电图随访18~72个月。①早期复发率22.38%(32/143),其中有12例动态心电图记录全程为持续房颤、房扑或房速,为比较房颤射频消融术后患者HRV值正常或降低及房性早搏频度与预后的关系,将此12例在之后窦性心律比较中剔除;晚期复发率9.92%(13/131),其中最晚复发者为射频术后4年。②器质性心脏病11例,早期复发3例,复发率27.27%;非器质性心脏病132例,早期复发29例,复发率21.97%。器质性心脏病与非器质性心脏病患者房颤射频消融术后早期预后比较无显著性差异(P>0.05)。③术后早期频发房性早搏9例,复发6例,复发率66.67%;偶发房性早搏122例,复发14例,复发率11.48%。房颤射频消融术后早期房性早搏频度与复发率比较,有极显著性差异(P<0.005)。④房颤射频消融术后早期HRV指标中SDNN值降低发生率52.67%(69/131),早期SDNN值正常或降低两组预后比较,早期和晚期复发均无显著性差异(P>0.05)。结论器质性心脏病患者亦可选择性行房颤射频消融并可Objective To investigate the relationship between heart rate variability(HRV)below normal and recurrence of atrial fibrillation(AF),and relationship between frequent atrial premature beats(APB)and AF recurrence in AF patients.Methods AF patients(n=143,male 71,female 72 and aged 59.90±11.12)received dynamic electrocardiogram(DCG)after radiofrequency ablation(RFA)were retrospectively analyzed in Beijing Shunyi District Hospital from Jan.2012 to Jan.2019.The patients undergone RFA after 1 month to 5 months were defined as early stage,and those undergone RFA after 6 month to 1 y and more than 1 y were defined as late stage.According to DCG results,frequent or accidental early APB and burst atrial tachycardia were divided into recurrence group and non-recurrence group after RFA.The standard deviation of normal RR interval(SDNN)or decreased SDNN of early sinus rhythm were divided into recurrence group and non-recurrence group after RFA(SDNN<100 ms as decrease,i.e.below normal).The pre-RFA organic heart disease(OHD)was divided into early recurrence group and early non-recurrence group after RFA.The times of APB and burst atrial tachycardia in DCG,SDNN values in HRV index,frequency and duration of AF and/or atrial flutter,and sustained atrial tachycardia were observed,compared and analyzed.Results DCG was followed up for 18 months to 72 months.①The early recurrent rate was 22.38%(32/143).There were 12 cases with DCG showed sustained AF,atrial flutter or atrial tachycardia in the whole course.In order to compare the relationship among normal HRV or HRV below normal,APB frequency and prognosis,these 12 cases were excluded from later comparison in sinus rhythm in AF patients after RFA.The later recurrent rate was 9.92%(13/131),and the latest recurrence was occurred after RFA for 4 y.②There were 11 cases of OHD,3 cases of early recurrence,and recurrent rate was 27.27%.There were 132 cases of non-OHD,29 cases of early recurrence,and recurrent rate was 21.97%.The comparison in early prognosis had no significant difference

关 键 词：心房颤动 射频消融术 心率变异性 频发房性早搏 复发 动态心电图 

分 类 号：R541.61[医药卫生—心血管疾病]