房颤射频消融术后空白期心律失常影响因素研究

Influencing factors of arrhythmia in blanking period of atrial fibrillation after radiofrequency ablation

目的探讨影响房颤射频消融术后空白期发生心律失常的因素及对远期复发影响,为今后开展患者术后健康教育、降低患者术后早期复发提供基础数据。方法收集2017年1月—2018年12月在福建医科大学附属协和医院进行射频消融治疗的383例房颤患者的住院及门诊资料,定期随访患者复发时间、服药情况、吸烟、喝酒、生活方式等情况,并检测随访患者身高、体质量、血压、腹围、24 h动态心电图等,按3个月内是否发生心律失常分组,分析患者术后空白期心律失常发生率及1年内复发率,并建立Logistic回归分析模型分析术后空白期发生心律失常的影响因素。结果术后1年复发检出率为26.6%,其中空白期心律失常发生率为16.4%,占心律失常总发生率的61.8%。女性出现空白期心律失常发生率(25.5%)明显高于男性(10.7%,P<0.01),血压异常患者空白期心律失常发生率(34.5%)明显高于血压正常患者(15.0%,P<0.05);多因素Logistic回归分析,服用他汀药物、女性、睡眠质量差、气温骤变心脏不适和血压高与空白期心律失常发生率呈正相关。结论术后空白期心律失常发生率较高,对远期预后有影响;睡眠质量差、女性、气温骤变心脏不适及血压控制不住是患者空白期心律失常发生的危险因素,服用他汀类药物不能减少患者空白期心律失常发生率,应加强术后患者的定期随访。

Objectives To analyze the influence factors of arrhythmia in the blanking period of atrial fibrillation after radiofrequency ablation and its effect on long-term recurrence,and in order to provide postoperative health education for patients and basic data for reducing the recurrence after operation.Methods The inpatient and outpatient data of 383 patients with atrial fibrillation who underwent radiofrequency ablation in Fujian Concord Hospital from January 2017 to December 2018 were collected.The information about recurrence time,medication,smoking,alcohol,lifestyle were followed up regularly in subjects,and in the same time detecting the height,weight,blood pressure,abdominal circumference,24 h dynamic electrocardiogram.The subjects were divided into groups according whether they had arrhythmia in 3 months,and the arrhythmia incidence of postoperative blanking period and recurrence rate within 1 year were calculated.Logistic regression analysis model was established to analyze the influencing factors of arrhythmia in the blank period after operation.Results The recurrence rate was 26.6%in 1 year after operation,and the incidence of arrhythmia in blanking period was 16.4%,accounting for 61.8%of the total incidence of arrhythmia.The incidence of arrhythmia in female in blanking period was higher than that of male(25.5%vs.10.7%,P<0.01).Arrhythmia rate in patients with abnormal blood pressure during the blanking period was significantly higher than that of patients with normal blood pressure(34.5%vs.15.0%,P<0.05).Multivariate logistic regression analysis showed that the use of statins,women,poor sleep quality,heart discomfort caused by sudden changes in temperature and high blood pressure were positively correlated with arrhythmia recurrence rate in blanking period.Conclusions The incidence of arrhythmia in the postoperative blanking period is high,which has an impact on long-term prognosis.Poor sleep quality,female,sudden temperature changes and bad blood pressure control were risk factors for the incidence of arrhythmia in the blanking period.Taking statins could not reduce the incidence of arrhythmia in the blanking period,and regular follow-up of postoperative patients should be strengthened.