一项前瞻性队列研究:心房颤动射频消融治疗术后出现不良结局的风险因素  

Risk factors for adverse outcomes in atrial fibrillation patients undergoing radiofrequency ablation:a prospective cohort study

作　　者：白瑾[1] 谢鹏昕 李延广 井然 李宗师 周公哺 刘书旺[1] BAI Jin;XIE Peng-xin;LI Yan-guang;JING Ran;LI Zong-shi;ZHOU Gong-bu;LIU Shu-wang(Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,State Key Laboratory of Vascular Homeostasis and Remodeling,Beijing 100191,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]北京大学第三医院心内科血管医学研究所血管稳态与重构全国重点实验室,北京100191 [2]首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所,北京100029

出　　处：《中国介入心脏病学杂志》2025年第3期121-127,共7页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(82300349)。

摘　　要：目的 本研究旨在分析影响接受射频消融治疗的心房颤动(房颤)患者术后发生主要不良心血管事件(MACE)的因素,并分析比较不同年龄房颤患者接受射频消融治疗的预后差异。方法 本研究持续入组2021年1月至2023年3月于北京大学第三医院接受射频消融治疗的房颤患者。通过医院住院系统收集患者一般数据。MACE收集通过门诊随访和电话随访。进一步按年龄将患者分为3组:组1(<65岁)、组2(65~75岁)、组3(>75岁),分析不同年龄患者的预后差异。在本研究中,MACE定义为心血管死亡、全因死亡、因心力衰竭再入院、急性冠状动脉综合征、脑卒中。结果 本研究共纳入431例患者,平均年龄为(66.17±12.22)岁。男259例(60.09%),CHA2DS2-VASc评分为(1.79±1.30)分。中位随访期为16.0(11.3,21.3)个月,在此期间发生MACE 28例(6.50%),其中多为急性冠状动脉综合征和脑卒中。采用LASSO回归法筛选变量,构建LASSO-Cox回归模型后,年龄(HR 1.06,95%CI 1.02~1.10,P=0.006)和肥厚型心肌病(HR 3.70,95%CI 1.27~8.68,P=0.008)是房颤射频消融治疗后出现MACE的独立预测因素。年龄分组结果,组1患者相比老年房颤患者具有显著更好的预后(与组2比较P=0.030;与组3比较P=0.021)。房颤患者(>75岁)接受射频消融治疗后的长期预后与65~75岁患者相似(P=0.600)。结论 年龄和肥厚型心肌病是房颤患者接受射频消融治疗后MACE的独立危险因素。非老年患者的预后显著优于老年患者(≥65岁),>75岁患者的预后与65~75岁患者相似。Objective To explore the factors that influence major adverse cardiovascular events(MACE) in atrial fibrillation(AF) patients undergoing radiofrequency ablation(RFA),as well as to compare the prognosis of patients with advanced AF to that of the general population.Methods We prospectively recruited AF patients who underwent RFA treatment at Peking University Third Hospital between January 2021 and March 2023.General patient data were collected through the hospital's inpatient system,and MACE were tracked through outpatient visits and telephone follow-ups.Patients were categorized into three age groups:Group 1(under 65 years),Group 2(65 to 75 years),and Group 3(over 75 years).In this study,MACE was defined as include cardiovascular death,all-cause death,readmission for heart failure,acute coronary syndrome(ACS),grade 2 or higher bleeding and stroke.Results A total of 431 patients were included in this study,with an average age of(66.17±12.22) years.Among these patients,259were male(60.09%),and the mean of CHA2DS2-VASc score was(1.79±1.30).The median follow-up period was 16.0(11.3,21.3) months,during which 28(6.50%) patients experienced MACE,with ACS and stroke being the most common events.Variables were selected using LASSO regression,and a LAS SO-Cox regression model was constructed.Age(HR 1.06,95%CI1.02-1.10,P=0.006) and hypertrophic cardiomyopathy(HR 3.70,95%CI 1.27-8.68,P=0.008)were identified as independent predictors of MACE after RFA for AF.Subgroup analysis revealed that patients under 65 had significantly better prognoses compared to older AF patients(P=0.030compared with group 2;P=0.021 compared with group 3).Conclusions Age and hypertrophic cardiomyopathy are independent risk factors for MACE in AF patients undergoing RFA.The prognosis for younger patients is better than that for older patients,while the prognosis for advanced patients is comparable to that of patients aged 65-75 years.

关 键 词：心房颤动 主要不良心血管事件 射频消融 年龄 肥厚型心肌病 

分 类 号：R54[医药卫生—心血管疾病]