女性非瓣膜性心房颤动患者临床特征及导管消融安全性分析

Clinical characteristics and safety of catheter ablation in female patients with non-valvular atrial fibrillation

目的探讨女性非瓣膜性心房颤动(AF)患者的临床特征及导管消融的安全性。方法回顾性分析自2019年1月至2020年12月于北部战区总医院接受导管消融治疗的457例女性AF患者的临床资料。按AF类型将患者分为持续性AF组(n=116)与阵发性AF组(n=341),比较两组患者的临床特征。分析射频消融术与冷冻球囊消融术患者并发症的发生情况。采用Logistic回归分析探讨持续性AF的影响因素。采用受试者工作特征曲线预测女性AF患者发生持续性AF的最佳截断点。结果持续性AF组年龄、体质量指数、氨基末端B型脑钠肽前体(NT-proBNP)、左房内径、左室内径、右房上下径、右房左右径均高于阵发性AF组,左室射血分数、合并其他类型心律失常比例均低于阵发性AF组,两组比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、左房内径、右房上下径、右房左右径是女性AF患者表现为持续性AF的影响因素(P<0.05)。左房内径为39.5 mm、右房上下径为38.5 mm、右房左右径为46.5 mm是预测女性AF患者发生持续性AF的最佳截断点,敏感性分别为69.1%、71.0%、79.7%,特异性分别为78.5%、75.1%、70.7%,受试者工作特征曲线下面积分别为0.801、0.779、0.798。两种术式患者的并发症发生率比较,差异无统计学意义(P>0.05)。结论女性AF患者导管消融安全性较高,应尽早启动节律控制治疗,改善心房重构,预防AF进展。

Objective To analyze the clinical characteristics and safety of catheter ablation in female patients with non-valvular atrial fibrillation(AF).Methods A retrospective analysis was performed on the clinical data of 457 female AF patients who underwent catheter ablation in General Hospital of Northern Theater Command from January 2019 to December 2020.Patients were divided into persistent AF group(n=116)and paroxysmal AF group(n=341)according to the type of AF,and the clinical characteristics of the two groups were compared.To analyze the complications of radiofrequency ablation and cryoballoon ablation.Logistic regression analysis was used to explore the influencing factors of persistent AF.Receiver operating characteristic curve was used to predict the optimal cut-off point for persistent AF in female AF patients.Results Persistent AF group of age,body mass index,N-terminal pro-B-type natriuretic peptide(NT-proBNP),left atrial diameter,left ventricular diameter,right atrium upper and lower diameter,right atrium left and right diameter were higher than in paroxysmal AF group,left ventricular ejection fraction,merging other types of arrhythmia ratio were lower than that of paroxysmal AF group,the differences were statistically significant(P<0.05).Logistic regression analysis results showed that age,left atrial diameter,right atrium upper and lower diameter,right atrium left and right diameter were the influencing factors for female AF patients with persistent AF(P<0.05).Left atrial diameter 39.5 mm,right atrium upper and lower diameter 38.5 mm,right atrium left and right diameter 46.5 mm were the best cut-off points for predicting the occurrence of persistent AF in female AF patients,with sensitivity of 69.1%,71.0%,79.7%,specificity of 78.5%,75.1%,70.7%,the areas under the receiver operating characteristic curve of subjects were 0.801,0.779 and 0.798,respectively.There was no significant difference in the incidence of complications between the two surgical procedures(P>0.05).Conclusion Catheter ablation is safe for female patients with AF.Rhythm control therapy should be initiated as soon as possible to improve atrial remodeling and prevent AF progression.