心房颤动环肺静脉电隔离术后无症状性复发的研究

Asymptomatic recurrence of atrial tachy-arrhythmia after circumferential pulmonary vein isolation in patients with atrial fibrillation

目的探讨心房颤动(房颤)环肺静脉电隔离术(CPVI)后无症状性复发的发生率、复发房性快速心律失常的类型及其预测因素。方法对连续48例接受 CPVI 治疗的房颤患者进行48 h动态心电图(Holter)随访,随访时间分别为术后1、3及6个月。对年龄、性别、房颤类型、是否合并有器质性心脏病、左房前后径、左室射血分数、操作时间、术后心率变异性等指标进行多因素 Logistic 回归分析,确定无症状性复发的预测因素。结果 48例患者中随访资料完整的42例,其中男26例,女16例,平均年龄58岁±14岁。术前为阵发房颤的25例,非阵发性房颤的17例。术后1、3、6个月阵发房颤组无症状性复发的发生率分别为8%、12%、8%;非阵发房颤组分别为23.5%、29.4%、35.3%。非阵发房颤组6个月时的无症状性复发率显著高于阵发房颤组(P<0.05)。CPVI 术后无症状性复发的心律失常类型以房颤多见,而症状性复发的心律失常类型则以房性心动过速多见。结论CPVI 术后部分患者存在尤症状性房颤复发。非阵发房颤、左房增大及术后正常 R-R 间期的标准差增加是预测 CPVI 术后出现无症状性复发的独立预测因素。

Objective To investigate the incidence, type, and predictors of asymptomatic relapse of atrial tachy-arrhythmia（ATa）after circumferential pulmonary vein isolation （CPVI） in patients with atrial fibrillation （AF）. Methods Forty-eight consecutive patients with AF underwent CPVI and were followed up. Forty-eight hours Hoher recording was performed 1, 3, and 6 months respectively after the initial CPVI procedure. Predictors of asymptomatic ATa relapse were determined by Logistic regression analysis for eight variables as follows： age, gender, AF type, existence of organic heart disease, diameter of left atria, left ventrieular ejection fraction, procedure time, and heart rate variability after the procedure. Results Complete Holter data were acquired in 42 patients, 26 males and 16 females, aged： 58 ± 14, including 25 patients with paroxysmal AF and 17 with non-paroxysmal AF. The standard deviations of R-R interval （SDNN） of the non-paroxysmal AF group was 92 ms ± 19 ms, significantly longer than that of the paroxysmal AF group （78 ms ± 15 ms, P = 0.011 ）. The incidence of asymptomatie ATa recurrence rates 1, 3 and 6 months after CPVI were 8% , 12% , and 8% respectively in paroxysmal AF group and 23.5% , 29.4% , and 35.3% respectively in the non-paroxysmal AF group. The incidence of asymptomatie ATa recurrence 6 months after CPVI in the non-paroxysmal AF group was significant higher than that in the paroxysmal AF group （ P 〈 0.05 ）. AF was the dominant arrhythmia among the asymptomatie recurrence ATa, while atrial taehyeardia constituted the major arrhythmia of the symptomatic recurrent ATa. Concinsion （1） Asymptomatic ATa relapse is common among the patients undergoing CPVI. （2）The dominant type of asymptomatie recurrent arrhythmia is AF. （ 3 ） The independent predictors for asymptomatie ATa recurrence include non-paroxysmal AF, left atrial enlargement, and increase of SDNN.