房室折返性心动过速射频消融术后复发的影响因素分析及预测模型的构建  

Risk factors of recurrence after radiofrequency ablation in patients with atrioventricular reentrant tachycardia and the construction of a prediction model

作　　者：王新明 王睦涵 田万禄 吕涛 WANG Xin-ming;WANG Mu-han;TIAN Wan-lu;LV Tao(Department of Cardiovascular Medicine,Affiliated Hospital of Chifeng University,Chifeng 024000,Inner Mongolia,China)

机构地区：[1]赤峰学院附属医院心血管内科,内蒙古赤峰024000

出　　处：《心脏杂志》2024年第5期521-526,共6页Chinese Heart Journal

摘　　要：目的探讨射频消融(radiofrequency catheter ablation,RFCA)治疗房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT)术后的复发率和影响因素,并构建预测模型。方法回顾性分析2019年1月~2022年10月在赤峰学院附属医院心血管内科治疗的554例AVRT接受RFCA患者的临床资料。根据术后定期随访有无AVRT复发,分为复发组46(8%)例和未复发组508(92%)例。通过单因素分析将术前基本资料、术中情况与术后复发情况进行比较,探讨两组患者的临床资料与AVRT患者RFCA术后复发的相关性;通过单因素和多因素Logistic回归分析,评估AVRT患者RFCA术后复发的独立影响因素;通过上述多因素分析结果构建回归方程和参数联合,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),计算参数联合预测AVRT患者术后复发的灵敏度和特异度;通过绘制列线图,评估单个参数对AVRT患者RFCA术后复发的诊断价值。结果接受RFCA治疗的AVRT随访时间超过3个月的患者,术后AVRT的复发率为8%。与未复发组比较,复发组既往心肌炎病史(P<0.05)、旁道位置(左侧降低、右侧、双侧升高,P<0.05),旁道数量(单旁道降低、多旁道升高,P<0.01)、术中诱发心动过速降低(P<0.05),消融反应时间延长(P<0.05)及射频消融巩固时间(P<0.05),均与研究对象RFCA术后复发有关。多因素回归分析结果显示,既往心肌炎病史、右侧和双侧旁道和旁道数量复杂是AVRT患者RFCA治疗术后复发的独立危险因素,术中诱发心动过速是AVRT患者RFCA治疗术后复发的保护因素(P<0.05)。根据多因素分析结果构建预测模型为Logit(P)=1.746×心肌炎病史+0.741×旁道位置+1.176×旁道数量-0.727×术中心动过速-3.386。ROC曲线评估参数联合预测AVRT患者RFCA治疗术后复发的敏感性和特异性分别为84.7%和54.9%,曲线下面积为0.746(95%CI:0.684~0.807)。基于上述临床参数构建列线图模型的似然比检验�AIM To Explore the postoperative recurrence rate and influencing factors of radiofrequency catheter ablation(RFCA)in the treatment of atrioventricular reentrant tachycardia(AVRT),and construct a predictive model.METHODS A retrospective analysis was conducted on the clinical data of 554 AVRT patients who underwent RFCA treatment at the Cardiovascular Department of Chifeng College Affiliated Hospital from January 2019 to October 2022.According to the regular follow-up after surgery for AVRT recurrence,there were 46(8%)cases in the recurrence group and 508(92%)cases in the non recurrence group.Compare preoperative basic information,intraoperative conditions,and postoperative recurrence through univariate analysis,and explore the correlation between clinical data of the two groups of patients and postoperative recurrence of RFCA in AVRT patients;Evaluate the independent influencing factors of RFCA postoperative recurrence in AVRT patients through univariate and multivariate logistic regression analysis;Based on the results of the above multiple factor analysis,a regression equation and parameter combination were constructed,and a receiver operating characteristic curve(ROC)was plotted to calculate the sensitivity and specificity of parameter combination in predicting postoperative recurrence in AVRT patients;Evaluate the diagnostic value of individual parameters for postoperative recurrence of RFCA in AVRT patients by drawing a column chart.RESULTS In AVRT patients receiving RFCA treatment,the recurrence rate of postoperative AVRT was 8% with a follow-up time of more than 3 months.Compared with the non recurrent group,the recurrent group had a history of myocarditis(P<0.05),accessory pathway location(decrease in left value,increase in right and bilateral values,P<0.05),number of accessory pathways(P<0.01),intraoperative induced tachycardia(P<0.05),prolonged ablation response time(P<0.05),and radiofrequency ablation consolidation time(P<0.05),All were related to postoperative recurrence of RFCA in the study subjects,a

关 键 词：房室折返性心动过速 射频消融术 复发 危险因素 预测模型 

分 类 号：R541.7[医药卫生—心血管疾病]