持续性心房颤动合并右心房扩大患者右心房的消融效果  

Right atrial ablation effect in patients with persistent atrial fibrillation combined with right atrial enlargement

作　　者：孙玉彰 董玉江[1] 吴绍辉 许长浩 朱希瑶 王乐天 姜伟峰[2] 张宇 刘旭[2] 秦牧 Sun Yuzhang;Dong Yujiang;Wu Shaohui;Xu Changhao;Zhu Xiyao;Wang Letian;Jiang Weifeng;Zhang Yu;Liu Xu;Qin Mu(The First Clinical Medical college of Shandong University of Chinese Medicine,Jinan 250355,China;Department of Cardiology,Shanghai Chest Hospital,School of Medicine,Shanghai Jiao Tong University,Shang hai 200025,China)

机构地区：[1]山东中医药大学第一临床学院,济南250355 [2]上海交通大学附属胸科医院心内科,上海200025

出　　处：《中华心律失常学杂志》2024年第4期333-338,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金资助项目(82370355)。

摘　　要：目的探讨持续性心房颤动(房颤)合并右心房扩大患者右心房消融干预的效果。方法本研究为对照研究。回顾性入选2018年1月至2020年6月在上海市胸科医院接受导管消融术,且合并右心房扩大的持续性房颤患者,分为左心房消融基础上接受右心房干预的患者组(右心房组)以及单纯左心房消融患者组(左心房组),比较两组患者术中房颤终止率,随访比较两组患者房颤复发率、右心房内径等指标。结果入选患者538例,年龄(66.90±8.30)岁,其中男123例。通过排除标准和倾向性评分1∶2匹配,纳入右心房组65例,左心房组130例,。右心房组中40例(61.50%,40/65)患者术中房颤终止,左心房组中43例(33.10%,43/130)患者术中房颤终止(P<0.001)。在12个月的随访中,右心房组房颤复发率低于左心房组[16.90%(11/65)对31.50%(41/130),P=0.025],与左心房组房颤术中未终止的患者比[16.90%(11/65)对46.00%(40/87),P≤0.002]。术后12个月超声心动图评估显示,患者右心房直径有所改善,但右心房组改变更为明显,且只有无房颤复发的患者右心房直径[(58.40±5.50)mm对(54.30±5.30)mm,P<0.001]显著改善。结论持续性房颤合并右心房扩大的患者在左心房消融的基础上干预右心房,可以降低房颤复发率并促进右心扩大的恢复。Objective To explore the effect of right atrial ablation intervention in patients with persistent atrial fibrillation(persistent atrial fibrillation,PerAF)combined with right atrium(right atrial,RA)enlargement.Methods It was a retrospective case-control study.Patients with PreAF undergoing catheter ablation in Shanghai Chest Hospital from January 2018 to June 2020 were collected.The atrial fibrillation(AF)termination rate,and the recurrence rate of AF and right atrial diameter was retrospectively compared in the two groups.Results A total of 538 patients were collected.Through exclusion criteria and 1∶2 propensity score matching,65 patients who accepted RA ablation(RA group)and 130 patients with left atrial alone(LA group)were included,age(66.90±8.30)years,males 123.The atrial fibrillation termination rate,and the recurrence rate of atrial fibrillation and right atrial diameter was compared in the two groups.Forty patients(61.50%,40/65)in the RA group achieved AF termination during the procedure,compared with 43(33.10%,43/130)patients(P<0.001)in the LA group.At 12-month follow-up,the AF recurrence rate was lower in the RA group[16.90%(11/65)vs.31.50%(41/130),P=0.025],especially compared to the patients without termination of AF in the LA group[16.90%(11/65)vs.46.00%(40/87),P=0.002].Echocardiographic evaluation at 12 months showed an improvement in overall RA diameter,but more pronounced changes in the RA group and only in patients without AF recurrence[(58.40±5.50)mm vs.(54.30±5.30)mm,P<0.001].Conclusion The intervention of the right atrium based on left atrial ablation in patients with PerAF combined with RA enlargement can reduce the rate of AF recurrence and promote the recovery of the right heart enlargement.

关 键 词：心房颤动 右心房扩大 导管消融 右心房干预 效果 

分 类 号：R541.75[医药卫生—心血管疾病]