环肺静脉消融治疗心房颤动后复发的临床预测因子

Clinical predictors of recurrence after circumferential ablation of pulmonary vein ostia to treat atrial fibrillation

目的:从临床角度寻找环肺静脉消融治疗心房颤动(Af)后复发的独立预测因子,探讨其应用的适用人群。方法:随访51例接受CARTO标测指导下环肺静脉消融的Af患者,根据基本临床资料,筛选影响手术成功的因素;进行多元Logistic回归分析,寻找复发的独立预测因子。结果:51例患者术后随访5～26(11.3±7.4)个月,14例复发列为复发组,无Af发作的37例列为窦性心律组。2组的基本临床资料回顾性研究表明,患者在Af病程、阵发性Af(PAf)比率、左心房直径(LAD)、术前超敏C反应蛋白(hCRPp)、术后房性期前收缩次数、术后短阵房性心动过速次数、术后3个月超敏C反应蛋白(hCRPf)等7个参数差异有统计学意义。对上述参数进行多元Logistic回归分析,发现PAf比率、LAD、hCRPp、hCRPf偏回归系数分别为-3.42、4.81、2.76、2.11,均P<0.01。结论:PAf、LAD、术前和术后3个月hCRP浓度是环肺静脉消融治疗Af的独立预测因子。

Objective：To find the independent predictors of recurrence after circumferential ablation of pulmonary vein to treat atrial fibrillation, to investigate the applicable population of the procedure. Method： Fifty-one patients with atrial fibrillation（Af） underwent CARTO mapping guided circumferential radiofrequency ablation of pulmonary vein were followed up. According to rhythm at the end of follow-up, patients were divided into sinus rhythm group （SR group） and recurrence group. The basic clinical data were compared to screening factors that affect the success rate. Multiple regression analysis was done to find the independent predictors. Result： Fifty-one patients were followed up for 5-26 （11.3±7.4） month. At the end of follow-up, 14 patients were recurred and were chosen as recurrence group, remainders were chosen as SR group. With a retrospective study of basic clinical data, we found that duration of Af, rate of paroxysmal Af（PAf）, left atrial diameter （LAD）, pre-ablation high activity C-reaction protein （hCRPp）, frequency of post-ablation atrial premature beats, frequency of post-ablation atrial tachycardia, post-ablation high activity C-reaction protein （hCRPf） were significant difference between the two groups. Studied by multiple regression analysis, PAl, LAD, hCRPp, hCRPf were independent predictors of recurrence. Conclusion： PAl, LAD,hCRPp,hCRPf were independent predictors of recurrence of atrial fibrillation after circumferential ablation of pulmonary vein.