持续性心房颤动射频消融术后复发的危险因素及其风险预测评估  

Risk factors and risk prediction for the recurrence of persistent atrial fibrillation after radiofrequency catheter ablation

作　　者：高贝贝 卞王露 李承宗 李菲 胡晓芹 葛力萁 张超群 王志荣 GAO Beibei;BIAN Wanglu;LI Chengzong;LI Fei;HU Xiaoqin;GE Liqi;ZHANG Chaoqun;WANG Zhirong(Department of General Practice,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Department of Cardiology,the Affiliated Hospital of Xuzhou Medical University)

机构地区：[1]徐州医科大学附属医院全科医学科,江苏徐州221002 [2]徐州医科大学附属医院心内科

出　　处：《徐州医科大学学报》2021年第9期651-655,共5页Journal of Xuzhou Medical University

基　　金：徐州市科技重点研发计划(KC19158)。

摘　　要：目的探讨持续性心房颤动(房颤)射频导管消融术后复发的危险因素及其可能的风险预测评估方法。方法本研究为单中心前瞻性观察性研究,连续选择2018年7月—2019年8月在徐州医科大学附属医院心内科首次行射频导管消融术的持续性房颤患者53例。记录患者相关临床资料,环肺静脉电隔离后行窦性心律下左房基质标测,平均随访16(12,21)个月,明确有无房颤复发,多因素回归分析探讨复发危险因素及预测复发风险。结果14例(26.42%)患者房颤复发。复发组较成功组平均P波时限(mPWD)显著延长(P<0.01),左房平均电压(mLAV)显著降低(P<0.01)。COX多因素回归分析显示mPWD及mLAV均为房颤复发的独立危险因素(P<0.05)。联合mPWD及mLAV指标构建预测模型,绘制ROC曲线预测房颤复发风险,AUC=0.90(95%CI 0.80~0.99,P<0.01),预测P值截点值为0.41,其诊断的敏感度、特异度分别为0.786、0.949。结论P波时限及左房电压可有效预测持续性房颤单次射频消融后的复发风险。Objective To investigate the risk factors and possible risk prediction methods concerning the recurrence of persistent atrial fibrillation(AF)after radiofrequency catheter ablation.Methods It was a single-center prospective observational study,where 53 patients with persistent AF,who underwent radiofrequency catheter ablation for the first time from July 2018 to August 2019 in Department of Cardiology,the Affiliated Hospital of Xuzhou Medical University,were consecutively enrolled.Their clinical data were recorded,while left atrial voltage mapping was performed after circle pulmonary vein isolation under sinus rhythm.The average follow-up visit time was 16(12,21)months to determine the presence of recurrence.COX multivariate analysis was conducted to explore the risk factors and predict the risk of recurrence.Results In the current study,14 patients(26.42%)showed atrial fibrillation recurrence.The recurrence group showed remarkably extended mean P wave duration(mPWD)(P<0.01)and reduced mean left atrial voltage(mLAV)(P<0.01),compared with the successful group.COX multivariate regression analysis showed that both mPWD and mLAV were the independent risk factors of atrial fibrillation recurrence(P<0.05).Both mPWD and mLAV indexes were adopted to establish a predictive model.A ROC curve was plotted to predict the risk of atrial fibrillation recurrence,with AUC=0.90(95%CI 0.80~0.99,P<0.01).The cut-off value of the predicted P value was 0.41,with a sensitivity and specificity of 0.786 and 0.949,respectively.Conclusions The duration of P wave and the left atrial voltage can effectively predict the recurrence risk of persistent atrial fibrillation after single radiofrequency catheter ablation.

关 键 词：心房颤动 射频导管消融 复发 P波时限 左房电压 

分 类 号：R541.75[医药卫生—心血管疾病]