青年非瓣膜性心房颤动患者经不同导管消融治疗效果及复发因素分析

Effect of different catheter ablation and recurrence factors in young patients with non-valvular atrial fibrillation

目的观察青年非瓣膜性心房颤动患者经不同导管消融的治疗效果并分析其复发因素。方法回顾性分析北部战区总医院自2018年8月至2020年8月收治的青年心房颤动患者的临床资料。通过电子病历系统收集患者的基本信息和实验室检查结果。术后3个月以及以后的每12个月对患者进行门诊或电话随访,记录患者复发情况。结果入组患者135例,平均年龄(38.67±5.32)岁,平均随访(35.34±9.30)个月。未复发(未复发组)97例,复发(复发组)38例。复发组空腹血糖水平高于未复发组,左房内径大于未复发组,差异有统计学意义(P<0.05)。复发组持续性心房颤动比例高于未复发组,差异有统计学意义(P<0.05)。冷冻球囊消融组合并其他心律失常比例低于射频消融组,差异有统计学意义(P<0.05)。射频消融组和冷冻球囊消融组复发率比较,差异无统计学意义(P>0.05)。持续性心房颤动患者术后复发风险较阵发性心房颤动患者高2.16倍(风险比2.16,95%可信区间1.04~4.78,P<0.05)。空白期复发患者术后复发风险较无空白期复发患者高8.08倍(风险比8.08,95%可信区间3.25~20.10,P<0.05)。随着左房内径和空腹血糖的升高,患者术后复发风险也升高,左房内径每增加1 mm,患者术后复发风险增加1.12倍(风险比1.12,95%可信区间1.03~1.23,P<0.05);空腹血糖每增加1 mmol/L,患者术后复发风险增加1.70倍(风险比1.70,95%可信区间1.16~2.48,P<0.05)。结论青年非瓣膜性心房颤动患者导管消融治疗成功率较高,患者应尽早接受导管消融治疗以进行节律控制,并严格控制血糖,降低术后复发风险。

Objective To observe the therapeutic effect of different catheter ablation in young patients with non-valvular atrial fibrillation and analyze the recurrence factors.Methods The clinical data of young patients with atrial fibrillation admitted to General Hospital of Northern Theater Command from August 2018 to August 2020 were retrospectively analyzed.Basic patient information and laboratory test results were collected through the electronic medical record system.Patients were followed up 3 months after surgery and every 12 months after surgery by outpatient or telephone to record the recurrence of patients.Results A total of 135 patients were enrolled,with an average age of(38.67±5.32)years and an average follow-up of(35.34±9.30)months.There were 97 cases without recurrence(non-recurrence group)and 38 cases with recurrence(recurrence group).The fasting blood glucose level of the recurrence group was higher than that of the non-recurrence group,and the left atrial diameter was larger than that of the non-recurrence group,and the differences were statistically significant(P<0.05).The proportion of persistent atrial fibrillation in the recurrence group was higher than that in the non-recurrence group,and the difference was statistically significant(P<0.05).The proportion of cryoballoon ablation combined with other arrhythmias was lower than that of radiofrequency ablation group,and the difference was statistically significant(P<0.05).There was no significant difference in the recurrence rate between the radiofrequency ablation group and cryoballoon ablation group(P>0.05).The risk of recurrence in patients with persistent AF was 2.16 times higher than that in patients with paroxysmal atrial fibrillation(hazard ratio 2.16,95%confidence interval 1.04-4.78,P<0.05).The risk of postoperative recurrence in patients with recurrence in blank period was 8.08 times higher than that in patients without recurrence in blank period(hazard ratio 8.08,95%confidence interval 3.25-20.10,P<0.05).With the increase of left atrial diameter and fasting blood glucose,the risk of postoperative recurrence also increased.For every 1 mm increase of left atrial diameter,the risk of postoperative recurrence increased by 1.12 times(hazard ratio 1.12,95%confidence interval 1.03-1.23,P<0.05).For every 1 mmol/L increase of fasting blood glucose the risk of postoperative recurrence was 1.70-fold increased(hazard ratio 1.70,95%confidence interval 1.16-2.48,P<0.05).Conclusion Catheter ablation is effective in the treatment of young patients with non-valvular atrial fibrillation.Rhythm control,inhibition of atrial remodeling and strict control of blood glucose should be applied as soon as possible to reduce the risk of postoperative recurrence of atrial fibrillation.