阵发性心房颤动冷冻球囊消融术后植入型心电监测仪的多中心应用体会  

Application of multicentric insertable cardiac monitor in paroxysmal AF patients after cryoballoon ablation

作　　者：罗迪[1] 刘彤[2] 刘恩照[2] 许静[3] 马薇[3] 谢瑞芹 叶岚[2] 许纲[2] 李广平[2] Luo Di;Liu Tong;Liu Enzhao;Xu Jing;Ma Wei;Xie Ruiqin;Ye Lan;Xu Gang;Li Guangping(Department of General Practice,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院全科医学科,300192 [2]天津医科大学第二医院心脏科,天津市心血管病离子与分子机能重点实验室,天津心脏病学研究所 [3]天津市胸科医院心内五病区 [4]河北医科大学第二医院心血管内科

出　　处：《中华老年心脑血管病杂志》2022年第5期472-475,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：天津市卫生健康委员会科技项目(ZC20125);天津医科大学第二医院临床医学研究项目(2019LC01)。

摘　　要：目的 探讨植入型心电监测仪(ICM)在阵发性心房颤动(房颤)患者冷冻球囊消融术后诊疗的价值。方法 连续入选2020年6月~2021年8月于天津医科大学第二医院、天津市胸科医院、河北医科大学第二医院阵发性房颤冷冻球囊消融术后ICM植入患者31例,1例退出研究,根据3个月内随访时是否房颤复发分为复发组12例和对照组18例。分别于术后1 d、1和3个月随访程控ICM及24 h Holter监测,分析ICM与24 h Holter心律失常检出情况,logistic回归分析复发相关因素。结果 31例患者均ICM植入,1例因术后囊袋内血肿形成退出试验。ICM术后1 d和3个月内房颤复发检出率显著高于24 h Holter(P=0.010,0.007)。复发组与对照组体质质量指数、血小板计数、NYHA分级、左心房内径(LAD)及左心室质量指数(LVMI)比较,差异有统计学意义(P<0.05)。LAD增大及LVMI增大为术后早期复发的危险因素(OR=27.278,95%CI:1.727~430.787,P=0.019;OR=23.420,95%CI:1.587~345.642,P=0.022)。结论 ICM可显著提高阵发性房颤冷冻消融术后3个月内早期复发的检出率,个体化设置ICM参数可以更好的为阵发性房颤冷冻球囊消融术后的监测及管理提供重要依据。LAD及LVMI为术后早期复发的预测指标。Objective To study the application of insertable cardiac monitor(ICM) in diagnosis and treatment of paroxysmal AF patients after cryoballoon ablation(CBA).Methods Thirty-one patients who underwent ICM implantation after CBA in Tianjin Medical University No.2 Hospital, Tianjin Chest Hospital and Hebei Medical University No.2 Hospital from June 2020 to August 2021 were divided into recurrent AF group(n=12) and control group(n=18) according to whether AF recurred during the 3-month follow-up period.The patients were followed up on day 1 and at months 1 and 3 after CBA,during which the ICM and 24 h dynamic ECG were monitored and analyzed.The AF recurrence-related factors were analyzed by logistic regression analysis.Results The 31 paroxysmal AF patients underwent ICM implantation with one withdrawn from our study because of hematoma formation in cryoballoon after CBA.The recurrence rate of AF was significantly higher on day 1 and at month 3 than on dynamic ECG after ICM implantation(P=0.010,P=0.007).Significant difference was detected in BMI,platelet count, NYHA grading, left atrial dimension(LAD) and left ventricular mass index(LVMI) between the two groups(P<0.05).LAD≥40 mm and elevated LVMI were risk factors for the early recurrence of AF after CBA(OR=27.278,95%CI:1.727-430.787,P=0.019;OR=23.420,95%CI:1.587-345.642,P=0.022).Conclusion ICM can effecttively improve the detection rate of early recurrence of AF within 3 months after CBA.LAD and LVMI are the risk factor for early recurrence of AF after CBA.

关 键 词：心房颤动 冷冻外科手术 复发 植入型心电监测仪 

分 类 号：R541.75[医药卫生—心血管疾病]