代谢综合征对老年心房颤动患者导管消融预后的影响

Influence of metabolic syndrome on the prognosis of atrial fibrillation treated with catheter ablation in elderly patients

目的探讨老年心房颤动（房颤）患者并存代谢综合征对导管消融成功率的影响。方法回顾性研究，入选2012年1月至2015年12月首次接受导管消融的221例老年房颤患者，根据患者临床资料分为代谢综合征组72例，年龄（67.1±5.2）岁，其中阵发性房颤46例；非代谢综合征组（对照组）149例，年龄（68.3±5.7）岁，其中阵发性房颤105例。比较随访结束时两组患者的临床预后。结果随访结束时，代谢综合征组及对照组手术成功率分别为27例（37.5%）与77例（51.7%），差异有统计学意义（χ^2＝3.917，P＝0.049）；复发的患者中，两组分别有42.2%（19/45）和38.9%（28/72）患者进行了2次消融。最后一次消融后分别有37例（51.4%），98例（65.8%）的患者维持窦性心律（χ^2＝4.224，P＝0.034）。多变量回归分析结果显示，代谢综合征（HR＝1.42，95%CI：1.11～1.64，P＝0.033）、左心房前后径（HR＝1.83，95%，CI：1.27～3.19，P＝0.017）是房颤导管消融术后长期随访复发的独立危险因素。结论代谢综合征影响老年房颤患者导管消融的成功率，即便是多次手术后，这一影响仍然存在。

Objective To assess the influence of metabolic syndrome（MS）on the success rate of catheter ablation for the treatment of atrial fibrillation（AF）in the elderly.MethodsA retrospective study included a total of 221 aged patients with AF who underwent AF ablation for the first time.The patients were divided into two groups： an MS group（n=72）and a control group（without MS）（n=149）. The MS group had a mean age of （67.1±5.2） years; the control group had a mean age of （68.3±5.7） years.Forty-six patients in the MS group and 105 patients in the control group experienced paroxysmal atrial fibrillation.Prognoses in two groups were compared at the end of the follow-up. ResultsAt the end of the follow-up, the success rates of the procedure in the MS group and the control group were 37.5%（n=27）and 51.7%（n=77）, respectively（χ^2=3.917, P=0.049）. Recurrence happened in 19 patients of the MS group and 28 patients of the control group, and they underwent a repeat ablation.The overall success rates after the last ablation in the two groups were 51.4%（n=37）and 65.8%（n=98）, respectively（χ^2=4.224, P=0.034）. In the multivariable model adjusted for risk factors, MS（HR=1.42, 95%CI： 1.11-1.64, P=0.033）and left atrial diameter（HR=1.83, 95%CI： 1.27-3.19, P=0.017）were independent predictors for recurrence.ConclusionsMS can affect the success rate of catheter ablation for AF in elderly patients and the effect remains even after the procedures are repeated