老年非瓣膜性房颤患者行经皮左心耳封堵联合射频消融术后发生不良结局的危险因素分析  

Risk factors for adverse outcomes in elderly patients with nonvalvular atrial fibrillation after percutaneous left atrial appendage closure combined with radiofrequency ablation

作　　者：苏秀甜 王华[2] 王广强 于婷[2] 任蒙蒙 仲琳 SU Xiu-tian;WANG Hua;WANG Guang-qiang;YU Ting;REN Meng-meng;ZHONG Lin(Shandong Second Medical University,Weifang,Shandong,261053,China)

机构地区：[1]山东第二医科大学,山东潍坊261053 [2]青岛大学附属烟台毓璜顶医院心内科

出　　处：《心血管康复医学杂志》2025年第2期162-167,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：国家自然科学基金(82200503)。

摘　　要：目的:探讨老年非瓣膜性心房颤动(房颤)患者行经皮左心耳封堵术(LAAC)联合射频消融术(RFA)后发生不良结局的危险因素。方法:纳入2019年1月1日至2023年8月17日于毓璜顶医院心内科住院并行LAAC联合RFA的老年房颤患者199例,根据术后1年内是否发生房性心律失常和/或脑梗死,将患者分为病例组(78例)和对照组(121例)。比较两组患者的基线临床资料、实验室指标和心超指标,采用多因素Logistic回归分析术后发生房性心律失常和/或脑梗死的危险因素,构建受试者工作特征(ROC)曲线分析危险因素对患者术后发生房性心律失常和/或脑梗死的预测效能。结果:单因素分析表明,与对照组比较,病例组术前持续性房颤(52.60%比37.20%)、陈旧性心肌梗死比例(11.50%比1.70%)及左心房内径[(45.47±6.90)mm比(43.34±6.64)mm]显著增加(P<0.05或<0.01)。多因素Logistic回归分析结果显示,陈旧性心肌梗死病史(OR=8.736,95%CI 1.772~43.069,P=0.008)和左心房内径(OR=1.053,95%CI 1.006~1.102,P=0.027)为老年房颤患者LAAC联合RFA术后不良结局的独立危险因素。ROC分析显示,陈旧性心肌梗死与左房内径联合检测预测老年房颤患者行LAAC联合RFA术后1年内发生不良结局的效能(AUC=0.663,95%CI 0.593~0.728)显著优于陈旧性心肌梗死(AUC=0.549,95%CI 0.477~0.620)、左房内径(AUC=0.602,95%CI 0.531~0.671)单项检测(Z=3.045、2.312,P=0.002、0.021)。结论:陈旧性心肌梗死病史和左心房内径是老年房颤患者行经皮左心耳封堵联合射频消融术后1年内发生房性心律失常和/或脑梗死结局的独立危险因素,二者联合具有良好的预测效能。Objective:To investigate the risk factors for adverse outcomes in elderly patients with nonvalvular atrial fibrillation(AF)after percutaneous left atrial appendage closure(LAAC)combined with radiofrequency ablation(RFA).Methods:A total of 199 elderly AF patients who admitted in Department of Cardiology,Yuhuangding Hospital between Jan 1 st,2019 and Aug 17 th,2023 and underwent LAAC combined RFA were enrolled.The patients were divided into case group(n=78)and control group(n=121)according to presence of atrial arrhythmia and/or cerebral infarction(CI)within one year after operation.Baseline clinical data,laboratory indexes and color Doppler ultrasound indexes were compared between the two groups,and multivariate Logistic regression was used to analyze the risk factors for postoperative atrial arrhythmia and/or CI.Receiver operating characteristic(ROC)curve was constructed to analyze the predictive efficacy of risk factors for atrial arrhythmia and/or CI after operation.Results:Univariate analysis indicated that compared with patients in control group,those in case group had significant higher proportions of preoperative persistent atrial fibrillation(52.60%vs.37.20%),old myocardial infarction(OMI)(11.50%vs.1.70%)and left atrial diameter(LAD)[(45.47±6.90)mm vs.(43.34±6.64)mm](P<0.05 or<0.01).Multivariate Logistic regression analysis indicated history of OMI(OR=8.736,95%CI 1.772~43.069,P=0.008)and LAD(OR=1.053,95%CI 1.006~1.102,P=0.027)were independent risk factors of adverse outcomes in elderly AF patients after LAAC+RFA.ROC analysis indicated that predictive efficacy of combined detection of OMI and LAD(AUC=0.663,95%CI 0.593~0.728)for adverse outcomes within 1 year in elderly AF patients after LAAC+RFA was significantly better than those of OMI(AUC=0.549,95%CI 0.477~0.620)and LAD(AUC=0.602,95%CI 0.531~0.671)alone(Z=3.045,2.312,P=0.002,0.021).Conclusion:History of old myocardial infarction and left atrial diameter are independent risk factors for atrial arrhythmia and/or cerebral infarction within 1 year after pe

关 键 词：心房颤动 导管消融术 危险因素 

分 类 号：R541.75[医药卫生—心血管疾病]