典型心房扑动患者行三尖瓣峡部消融术后新发心房颤动的危险因素分析  

Risk factors of newly-onset atrial fibrillation in patients with typical atrial flutter after cavotricuspid isthmus ablation

作　　者：马继芳[1] 宋卫锋[1] 陈珂[1] 臧小彪[1] 周游 王现青[1] 赵永辉[1] 付海霞[1] MA Jifang;SONG Weifeng;CHEN Ke;ZANG Xiaobiao;ZHOU You;WANG Xianqing;ZHAO Yonghui;FU Haixia(Department of Cardiology,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院,阜外华中心血管病医院心内科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第10期1036-1041,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200071)。

摘　　要：目的观察典型心房扑动患者行三尖瓣峡部消融术后3年内新发心房颤动(房颤)情况,探讨其新发房颤的危险因素。方法2016年1月—2018年5月阜外华中心血管病医院诊治典型心房扑动患者132例,均行三尖瓣峡部消融术治疗,术前均行生活质量评分、心理量表评分、实验室检查及超声心动图检查。术后随访3年,根据是否新发房颤将132例患者分为新发房颤组27例与窦性心律组105例,末次随访时行生活质量评分及心理量表评分,比较2组有饮酒史、合并高血压比率等临床资料,术前实验室检查(血脂、尿酸、脑钠肽水平等)、超声心动图指标(左心房前后径、右心房左右径、左心室收缩末期内径、左心室舒张末期内径、左室射血分数、三尖瓣反流),术后生活质量评分、心理量表评分变化情况及随访期间新发脑梗死/短暂性脑缺血、因心血管事件再入院发生率。采用多因素logistic回归分析典型心房扑动患者行三尖瓣峡部消融术后3年内新发房颤的影响因素;绘制Kaplan-Meier生存曲线,比较2组术后3年内因心血管事件再入院发生率。结果132例典型心房扑动患者随访期间新发房颤27例(20.45%)。新发房颤组有饮酒史、合并高血压、睡眠呼吸暂停比率(29.63%、44.44%、14.81%)均高于窦性心律组(9.52%、20.00%、1.90%)(P<0.05),左心房前后径[(37.66±9.48)mm]大于窦性心律组[(30.60±11.66)mm](t=-2.902,P=0.004),血浆总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、尿酸、脑钠肽水平及右心房左右径、左心室收缩末期内径、左心室舒张末期内径、左室射血分数、三尖瓣反流比率与窦性心律组比较差异均无统计学意义(P>0.05)。饮酒是典型心房扑动患者行三尖瓣峡部消融术后3年内新发房颤的影响因素(OR=0.219,95%CI:0.068~0.704,P=0.011)。新发房颤组躯体健康评分降低、精神健康评分降低、焦虑自评量表�Objective To observe the newly-onset atrial fibrillation(AF)within 3 years after cavotricuspid isthmus ablation in patients with typical atrial flutter,and to investigate the risk factors of newly-onset AF.Methods Totally 132patients with typical atrial flutter underwent cavotricuspid isthmus ablation from January 2016 to May 2018 in Fuwai Central China Cardiovascular Hospital.The score of quality of life(QOL),psychological scale score,laboratory examination and echocardiography results were evaluated before operation.The patients were followed up for 3 years and were divided into newly-onset AF group(n=27)and sinus rhythm group(n=105)according to the presence and absence of newly-onset AF.The score of QOL and psychological scale score were evaluated at the latest follow-up.The clinical data(including alcohol consumption and hypertension),preoperative laboratory examination(blood lipids,uric acid,brain natriuretic peptide),echocardiography examination(left atrial anteroposterior diameter,right atrial left-right diameter,left ventricular end-systolic dimension,left ventricular end-diastolic dimension,left ventricular ejection fraction,tricuspid regurgitation),postoperative score of QOL,psychological scale score,incidence of newly-onset cerebral infarction/transient cerebral ischemia and rate of re-hospitalization due to cardiovascular events during follow-up were compared between two groups.Multivariate logistic regression analysis was done to assess the influencing factors of newly-onset AF within 3 years after cavotricuspid isthmus ablation in patients with typical atrial flutter.Kaplan-Meier survive curves were plotted to compare the rate of re-hospitalization due to cardiovascular events within 3 years between two groups.Results In 132 patients,newly-onset AF developed in 27 patients(20.45%).The percentages of patients with alcohol consumption,hypertension and sleep apnea hyponea syndrome were higher in newly-onset AF group(29.63%,44.44%,14.81%)than those in sinus rhythm group(9.52%,20.00%,1.90%)(P<0.05),the l

关 键 词：典型心房扑动 心房颤动 三尖瓣峡部消融术 

分 类 号：R541.75[医药卫生—心血管疾病]