导管消融后需永久起搏的阵发性心房颤动合并快慢综合征患者临床特点及相关因素  

Clinical Features and Related Factors in Patients with Paroxysmal Atrial Fibrillation and Tachycardia-Bradycardia Syndrome Requiring Permanent Pacing After Catheter Ablation

作　　者：王凡[1] 马继芳[2] 周游 赵晨晨 胡光玲[3] 付海霞 WANG Fan;MA Jifang;ZHOU You;ZHAO Chenchen;HU Guangling;FU Haixia(Henan University People's Hospital,Zhengzhou 450003,China;Arrhythmia Ward 2,Heart Center of Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China;Arrhythmia Ward 1,Heart Center of Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院,河南郑州450003 [2]河南省人民医院心脏中心阜外华中心血管病医院心律失常二病区,河南郑州450003 [3]河南省人民医院心脏中心阜外华中心血管病医院心律失常一病区,河南郑州450003

出　　处：《河南医学研究》2023年第9期1559-1564,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220130);河南省科技发展计划(17210241001)。

摘　　要：目的 部分阵发性心房颤动(简称房颤)合并快慢综合征(TBS)患者导管消融(CA)后仍因症状性心动过缓需要植入永久起搏器,探究此部分患者的临床特点及需要起搏的相关因素。方法 2018年1月1日至2021年12月31日在阜外华中心血管病医院有39例阵发性房颤合并TBS患者接受CA后又因症状性心动过缓植入了永久起搏器,收集患者相关资料,分析此类患者临床特点、CA结果、植入起搏器原因及时间特点,并与同期年龄、性别、左房大小相匹配的39例CA后不需永久起搏TBS患者进行对比研究,筛选TBS患者CA后需永久起搏治疗的危险因素。结果 该组需起搏患者年龄(62.79±8.74)岁,男性25例(64.10%),随访(25.54±6.96)个月,单次消融成功25例(64.10%),多次消融成功29例(74.36%)。71.79%患者起搏器植入时间为CA同期住院或空白期内,1 a后植入起搏器仅有3例(7.69%)。11例(28.21%)因器质性窦房结功能障碍(SND)植入起搏器,余均因快速房性心律失常(ATA)事件后窦性停搏植入起搏器。多因素分析发现,最长长间歇长及长间歇发生在非夜间(06:00—24:00)是患者需行永久起搏的独立危险因素(P<0.05)。结论 阵发性房颤合并TBS患者CA成功率高,仍需植入起搏器的患者起搏器植入时间大多为围手术期或CA空白期,1/4的植入原因为器质性SND,最长长间歇长及长间歇发生于非夜间是此类患者的临床特点。Objective Some patients with paroxysmal atrial fibrillation(atrial fibrillation)complicated with tachycardia-bradycardia syndrome(TBS)still need permanent pacemaker implantation due to symptomatic bradycardia after catheter ablation(CA),so as to explore the clinical characteristics and related factors of pacing in these patients.Methods From January 1,2018 to December 31,2021,39 patients with paroxysmal atrial fibrillation and TBS received CA and then had permanent pacemakers implanted due to symptomatic bradycardia,and relevant data of such patients were collected,the clinical characteristics,CA results,reasons and time characteristics of pacemaker implantation were analyzed,and 39 patients with CA who did not need permanent pacing TBS matched with the age,gender and left atrial size of the same period were compared with 39 patients with CA who did not need permanent pacing TBS.Screening patients with TBS for risk factors requiring permanent pacing therapy after CA.Results The age of pacing patients was(62.79±8.74)years,25 males(64.10%),with follow-up of(25.54±6.96)months,25 cases(64.10%)had successful single ablation,and 29 cases(74.36%)had success multiple ablation.The patients(71.79%)had pacemaker implantation at the same time as CA hospitalization or blank period,and only 3(7.69%)had pacemakers implanted after 1 year.Eleven patients(28.21%)had pacemakers implanted due to organic sinus node dysfunction(SND),and the rest were implanted pacemakers due to sinus arrest after atrial tachyarrhythmia(ATA)events.Multivariate analysis found that long longest intervals and long intervals occurring non-nocturnal(06:00—24:00)were independent risk factors for permanent pacing(P<0.05).Conclusion Patients with paroxysmal atrial fibrillation and TBS have a high success rate of CA,and most of the pacemakers who still need to be implanted have a perioperative or blank period,and a quarter of the implantation reasons are organic SND,and the clinical characteristics of such patients are long longest intervals and long interv

关 键 词：心房颤动 快慢综合征 导管消融 起搏器 

分 类 号：R541.75[医药卫生—心血管疾病]