肺静脉隔离术后心房颤动早期复发和延迟愈合的相关因素分析

Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for atrial fibrillation

目的探讨Lasso标测导管指导下行节段性肺静脉电隔离术后心房颤动(房颤)早期复发和延迟愈合的相关因素。方法120例[男性104例,女性16例;平均年龄(50．4±8．9)岁]行节段性肺静脉电隔离术的房颤患者,单因素和多因素分析老龄(≥60岁)、性别、房颤类型、病史、合并高血压、左心房直径、射血分数、P波离散度、被隔离肺静脉数及手术时间与早期复发和延迟愈合的相关性。结果早期复发率为48．3％(58／120),左心房扩大(P=0．004)和老龄(P=0．033)与早期复发显著相关,左心房直径是早期复发的独立预测因素(OR=1．16,95％CI为1．04～1．28,P=0．005);延迟愈合率为29．3％(17／58),与延迟愈合显著相关的变量为:P波离散度(P<0.001)、左心房直径(P=0．016)、老龄(P=0．001)。P波离散度是延迟愈合的独立预测因素(OR=0．92,95％CI为0．87-0．97,P=0．005)。结论左心房扩大、老龄与肺静脉隔离术后房颤早期复发有关,左心房直径是早期复发的独立预测因素;P波离散度较小、左心房无扩大的低龄患者延迟愈合的可能性较大,P波离散度是延迟愈合的独立预测因素。

Objective To investigate the predictive factors for early recurrence and delayed cure after segmental pulmonary vein isolation for atrial fibrillation （AF）. Methods In 120 [ mail in 104 ,female in 16; age（50. 4 ± 8. 9） years ] consecutive patients with paroxysmal （ n = 99 ） or persistent （ n = 21 ） AF, segmental PV electrical isolation with Lasso mapping catheters was performed. The relationship between early recurrence or delayed cure and clinical variables including advanced age, sex, type of AF, duration of AF, presence of hypertension,left atrial diameter,left ventricular ejection fraction, P-wave dispersion, number of isolated PVs, procedure time were analyzed respectively by univariate analysis and stepwise multivariate regression analysis Results 48. 3% （58/120） AF patients had early recurrence. Univarlate analysis revealed that left atrial enlargement （ P = 0. 004） and advanced age （ P = 0. 033 ） were significantly related to early recurrence of AF after procedure. Logistic regression analysis revealed that left atrial diameter was the only independent risk factor of early recurrence （ OR = 1.16,95% CI 1.04- 1.28, P = 0. 005 ）. AF disappeared in 29. 3% （ 17/58 ） patients who had early recurrence. P-wave dispersion （ P 〈0. 001 ） , left atrial diameter （ P = 0. 016 ） and advanced age （ P = 0. 001 ） were significantly related to delayed cure. P-wave dispersion was the independent predictor of delayed cure （ OR = 0. 92,95% CI 0. 87 -0. 97, P = 0. 005 ）. Conclusion AF patients with left atrial enlargement and advanced age are more susceptible to early recurrence after initial ablation. Left atrial diameter is the independ- ent risk factor of early recurrence. In patients with early recurrence, younger patients with less P-wave dispersion and less atrial diameter have higher probability of delayed cure. P-wave dispersion is the independent predictor of delayed cure.