导管消融与药物治疗心房颤动逆转功能性瓣膜反流的疗效对比  

Comparison of therapeutic effects of catheter ablation and drugs on reversing functional valvular regurgitation in patients with atrial fibrillation

作　　者：陈丽 邓金龙[1] 吴东峰[1] 卢锋[1] 沈洁 陈辉[1] 张赛敏 黄迪 祝杏冰 张欣华 李永铭 陈浩妮 赵泽源 CHEN Li;DENG Jin-long;WU Dong-feng;LU Feng;SHEN Jie;CHEN Hui;ZHANG Sai-min;HUANG Di;ZHU Xing-bing;ZHANG Xin-hua;LI Yong-ming;CHEN Hao-ni;ZHAO Ze-yuan(The Cardiovascular Department of the People’s Hospital of Guangxi Zhuang Autonomous region,530021 Nanning,China)

机构地区：[1]广西壮族自治区人民医院老年心血管内科,广西壮族自治区南宁市530021

出　　处：《中国心血管病研究》2025年第2期121-125,共5页Chinese Journal of Cardiovascular Research

基　　金：广西科学研究与技术开发计划(桂科攻1598012-2);广西自然科学基金(2023GXNSFAA026334)。

摘　　要：目的研究导管消融与药物治疗对心房颤动(房颤)患者中、重度功能性二、三尖瓣反流的影响,探讨与瓣膜反流改善有关的预测因素。方法入选2020年1月至2023年12月在广西区人民医院住院的房颤合并中、重度功能性二、三尖瓣反流的患者(n=96),根据患者有无行导管消融术,分为消融组(n=50)与药物组(n=46)。所有患者治疗后至少3个月后至我院完成随访,复查心电图和超声心动图。比较治疗前后两组患者的瓣膜反流改善情况,并探讨与瓣膜反流改善有关的因素。结果消融组二尖瓣反流和三尖瓣反流改善较药物组显著(P<0.01)。消融组患者恢复窦性心律者为39例,药物组为8例(78%比17.4%,P<0.05)。多因素Logistic回归分析显示,年龄小和恢复窦律房颤患者功能性二、三尖瓣反流改善的独立预测因素(P<0.05)。结论相比药物治疗,导管消融治疗房颤逆转功能性瓣膜反流的效果更显著。年龄小与恢复窦律是房颤患者功能性瓣膜反流改善的独立预测因素。Objective To explore the effects of catheter ablation and drug therapy on moderate to severe functional mitral regurgitation or tricuspid regurgitation in patients with atrial fibrillation(AF),and the predictive factors related to the improvement of valvular regurgitation.Methods The AF patients(n=96)with moderate to severe functional mitral regurgitation and tricuspid regurgitation admitted to the cardiovascular department of the People’s Hospital of Guangxi Zhuang Autonomous region from January 2020 to December 2023 were included.According to whether the patients underwent catheter ablation or not,they were divided into catheter ablation group(n=50)and drug group(n=46).All the patients were followed up in our hospital at least three months after catheter ablation or drug treatment.ECG and cardiac color ultrasound examination were performed.The improvement of valvular regurgitation after treatment between the two groups was compared,and the predictive factors related to the improvement were explored.Results Compared with the drug group,the improvement of mitral regurgitation and tricuspid regurgitation was more significant in the catheterablation group(P<0.01).Sinus rhythm was recovered in 39 patients in the catheter ablation group(78%vs.17.4%P<0.05).Multivariate Logistic regression analysis showed that maintenance of sinus rhythm and younger were the independent predictors of improvement of mitral and tricuspid regurgitation in the patients with AF(P<0.05).Conclusions The effect of reversing functional valvular regurgitation of catheter ablation of AF is more significant compared with drug therapy.Relative youth and maintenance of sinus rhythm are independent predictors of functional valvular regurgitation in patients with AF.

关 键 词：心房颤动 导管消融术 药物 二尖瓣反流 三尖瓣反流 

分 类 号：R541.7[医药卫生—心血管疾病]