房颤冷冻球囊消融术后复发与围手术期房性快速性心律失常及心肌肌钙蛋白的关系  

Correlation between recurrence of atrial fibrillation after cryoballoon ablation,and perioperative atrial tachyarrhythmia and cardiac troponin

作　　者：储锐锐 王岳松 董学滨 邵旭武 王学忠 CHU Ruirui;WANG Yuesong;DONG Xuebin;SHAO Xuwu;WANG Xuezhong(Department of Cardiovascular Medicine,Maanshan Clinical College,Anhui Medical University,Maanshan Anhui 243000,China)

机构地区：[1]安徽医科大学马鞍山临床学院心血管内科,安徽马鞍山243000

出　　处：《实用心电学杂志》2022年第6期416-421,共6页Journal of Practical Electrocardiology

基　　金：马鞍山市科技计划项目(YL-2021-08)。

摘　　要：目的探讨房颤二代冷冻球囊消融(cryoballoon ablation,CBA)术后复发与围手术期房性快速性心律失常(atrial tachyarrhythmia,AT)和心肌肌钙蛋白I(cTnI)的相关关系。方法选取45例接受CBA治疗的房颤患者,根据消融空白期(3个月)后是否出现AT分为复发组和非复发组。对比分析两组患者的临床资料、实验室检查结果、手术参数、并发症和随访资料。结果①术后平均随访(14.3±3.7)个月,非复发组仍有31例患者维持窦性心律,复发组有14例患者房颤复发,成功率68.9%;非复发组和复发组分别有5例(16.1%)和10例(71.4%)发生围手术期AT,且差异有统计学意义(P<0.01),但二元Logistic回归分析表明,围手术期AT与房颤术后复发无明显相关性(OR=5.95,P>0.05)。②术后6 h cTnI复发组低于非复发组[(7.4±1.9)ng/mL vs.(11.8±3.1)ng/mL,P<0.01],且回归分析提示术后6 h cTnI与术后房颤复发具有相关性(OR=0.56,P=0.034)。③亚组分析发现,CBA术后在12例持续性房颤和33例阵发性房颤患者中,分别有5例(41.7%)和9例(27.3%)复发,且差异无统计学意义(P>0.05)。结论CBA治疗阵发性和持续性房颤均安全有效。术后cTnI水平监测有助于快速预测CBA术后房颤的复发,并为二次消融提供临床依据。Objective To investigate the correlation between the recurrence of atrial fibrillation(AF)after second-generation cryoballoon ablation(CBA),and perioperative atrial tachyarrhythmia(AT)and cardiac troponin I(cTnI).Methods Forty-five AF patients undergoing CBA were enrolled,and divided into recurrence group and non-recurrence group according to the presence or absence of AT after the ablation blanking period(3 months).Clinical data,laboratory examination results,surgical parameters,complications and follow-up data of the two groups were comparatively analyzed.Results(ⅰ)At a mean follow-up period of(14.3±3.7)months after ablation,sinus rhythm still maintains in 31 patients of the non-recurrence group while AF recurs in 14 patients of the recurrence group,with a success rate of 68.9%.Perioperative AT occurs in 5 cases(16.1%)of the non-recurrence group and 10(71.4%)cases of the recurrence group,respectively,with statistically significant difference(P<0.01).However,binary Logistic regression analysis shows no significant correlation between perioperative AT and AF recurrence after ablation(OR=5.95,P>0.05).(ⅱ)The cTnI level 6 hours after operation in the recurrence group is lower than that in the non-recurrence group[(7.4±1.9)ng/mL vs.(11.8±3.1)ng/mL,P<0.01].Regression analysis suggests a correlation between cTnI level 6 hours after ablation and postoperative AF recurrence(OR=0.56,P=0.034).(ⅲ)Subgroup analysis reveals that among 12 patients with persistent AF and 33 patients with paroxysmal AF,AF separately recurs in 5(41.7%)and 9(27.3%)cases after CBA,without statistically significant difference(P>0.05).Conclusion CBA is safe and effective in treating both paroxysmal and persistent AF.Monitoring for postoperative cTnI level helps to rapidly predict the recurrence of AF after CBA,and provide clinical references for a secondary ablation.

关 键 词：房颤 阵发性房颤 持续性房颤 冷冻球囊消融 导管射频消融 房性心律失常 血清肌钙蛋白 

分 类 号：R541.75[医药卫生—心血管疾病]