心房颤动导管消融术后48h内极早期复发与晚期复发的相关性  

The correlation between early recurrence and late recurrence within 48 hours after catheter ablation of atrial fibrillation

作　　者：樊永强 魏猛 吕华胜 芦颜美[1] Fan Yongqiang;Wei Meng;Lyu Huasheng;Lu Yanmei(Department of Pacing and Electrophysiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;The Fifth Affiliated Hospital of Jinan University(Heyuan Shenhe People's Hospital),Heyuan 517000,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科,乌鲁木齐830054 [2]暨南大学附属第五医院(河源市深河人民医院),河源517000

出　　处：《中国医师杂志》2024年第7期1053-1059,共7页Journal of Chinese Physician

基　　金：新疆维吾尔自治区天山英才-青年拔尖科技人才项目(2022TSYCCX0101)。

摘　　要：目的探讨心房颤动(简称房颤)导管消融术后48 h内极早期复发与晚期复发的相关性。方法回顾性分析2020年4月至2021年11月在新疆医科大学第一附属医院心脏中心行导管消融的房颤患者。收集患者术前检查和基线资料。术后给予患者48 h持续心电监测,观察是否存在极早期的房颤复发,并于术后3、6、9、12个月对患者进行随访,观察是否存在房颤事件。采用Kaplan-Meier曲线分析极早期复发对晚期复发的影响,使用Cox比例风险模型和受试者工作特征(ROC)曲线评估极早期复发及其他指标对房颤晚期复发的预测价值。结果本研究共纳入96例首次行房颤导管消融的患者,年龄(60.2±12.6)岁,其中46例(47.92%)患者在术后48 h内发生了极早期复发。在1年的随访过程中,极早期复发组患者中持续性房颤占比更高[32.6%(15/46)vs 8.0%(4/50),P=0.006],发生晚期复发的患者更多[34.8%(16/46)vs 8.0%(4/50),P=0.003],左心房内径更大[(40.28±4.72)mm vs(37.10±4.35)mm,P=0.001]。Kaplan-Meier曲线显示与极早期非复发组相比,极早期复发组患者的晚期复发率明显更高(Long-rankP=0.0016)。Cox单因素回归分析提示极早期复发、年龄增长、左心房内径增加、合并高血压和糖尿病是晚期复发的危险因素(均P<0.2)。多因素回归分析提示,极早期复发是晚期复发的独立危险因素(HR=3.99,95%CI:1.22~13.06,P=0.021)。极早期复发预测房颤导管消融术后晚期复发的ROC曲线下面积为0.703,阴性预测值为0.920。结论房颤导管消融术后48 h内的极早期复发是晚期复发的独立危险因素且具有较好的预测价值。Objective To investigate the correlation between early recurrence and late recurrence within 48 hours after catheter ablation of atrial fibrillation.Methods A retrospective analysis was conducted on atrial fibrllation patients who underwent catheter ablation at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from April 2020 to November 2021.Preoperative examinations and baseline data of patients were collected.After surgery,the patient was given continuous electrocardiogram monitoring for 48 hours to observe whether there was early recurrence of atrial fibrillation.Follow up visits were conducted at 3,6,9,and 12 months after surgery to observe whether there were atrial fibrillation events.The impact of extremely early recurrence on late recurrence free atrial fibrllation was analyzed using Kaplan Meier curves,and the predictive value of extremely early recurrence and other indicators for late atrial fibrllation recurrence was evaluated using Cox proportional hazards models and receiver operating characteristic(ROC)curves.Results A total of 96 patients who underwent catheter ablation for atrial fibrillation for the first time were included in this study,with an age of(60.2±12.6)years.Among them,46 patients(47.92%)experienced very early recurrence within 48 hours after surgery.During the 1-year follow-up,16 patients in the very early recurrence group experienced late recurrence,which was statistically significant compared to the very early non recurrence group(P=0.003).The proportion of persistent atrial fibrillation was higher in patients with very early recurrence(32.6%vs 8.0%,P=0.006),and more patients with late recurrence(34.8%vs 8.0%,P=0.003).The left atrial diameter was larger[(40.28±4.72)mm vs(37.10±4.35)mm,P=0.001].The Kaplan Meier curve showed that compared with the very early non recurrence group,the late recurrence rate of patients in the very early recurrence group was significantly higher(Long rank P=0.0016).Cox single factor regression analysis showed that very earl

关 键 词：心房颤动 导管消融术 复发 

分 类 号：R541.75[医药卫生—心血管疾病]