心房颤动射频消融术中出现规律性快速性房性心律失常的预测因素

Predictors of Regular Atrial Tachyarrhythmias in Patients with Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation

目的:分析心房颤动(简称房颤)经导管射频消融术中出现心房扑动、房性心动过速等规律性快速性房性心律失常(RATs)的预测因素。方法:首次行经导管射频消融治疗的497例房颤患者(阵发性房颤333例,持续性和(或)永久性房颤164例)在三维标测系统及环状标测电极导管指导下行经导管射频消融治疗(包括环肺静脉电隔离、线性消融和(或)碎裂电位消融)。术中记录RATs的发生情况,并分析RATs的可能影响因素。结果:术中共有163例患者[32.8%;阵发性房颤92例,持续性和(或)永久性房颤71例]出现195种RATs,持续性和(或)永久性房颤术中RATs的发生率显著高于阵发性房颤(43.3%比27.6%,P<0.001)。单因素分析发现心脏外科术后(P<0.001)、术前有RATs(P=0.010)、持续性和(或)永久性房颤(P<0.001)、左房内径增大(P<0.001)、左室射血分数降低(P=0.018)是房颤术中出现RATs的影响因素。Logistic多因素回归分析发现心脏外科术后[优势比(OR)=8.14,95%可信区间(CI):1.69～39.1,P=0.009]、术前有RATs[OR=2.15,95%CI:1.35～3.42,P=0.001]、持续性和(或)永久性房颤[OR=1.71,95%CI:1.06～2.76,P=0.029]、左房内径[OR=1.04,95%CI:1.01～1.08,P=0.025]是术中出现RATs的独立预测因素。结论:房颤射频消融术中常出现RATs,心脏外科术后、术前有RATs、持续性和(或)永久性房颤、左房内径是术中出现RATs的独立预测因素。

Objective：To investigate the predictors of regular atrial tachyarrhythmias （RATs, including atrial flutter and atrial tachycardia） during operation in patients with atrial fibrillation （AF） who underwent radiofrequency catheter ablation（RFCA）. Methods： A total of 497 consecutive patients with AF, who underwent RFCA for the first time guided by a three-dimensional mapping system and a circular mapping catheter, were included in this study. The ablation strategy included circumferential pulmonary veins isolation （CPVI）, linear ablation and/or complex fractionated atrial electrograms ablation. RATs during ablation were recorded and those factors which maybe associated with RATs were analyzed. Results： RATs were indentified in 163 patients（32.8%, paroxysmal AF 92, persistent/permanent AF 71）, the incidence of RATs in persistent/permanent AF was higher than that of paroxysmal AF （43.3% vs. 27.6%, P〈0. 001） o Left atrial diameter （LAD, P〈0. 001）, lower left ventricular ejection fraction （P = 0. 018）, persistent/permanent AF （P〈0. 001）, a history of RATs before ablation （P = 0. 010） and post cardiac surgery （PCS, P〈0. 001） were identified as predictors of RATs by univariate analysis. PCS [odd ratio （OR） =8.14, 95% confidence interval （CI）： 1.69-39. 1,P=0.009], a history of RATs [OR=2.15, 95~ CI： 1.35-3.42, P= 0.001], persistent/permanent AF[OR= 1.71, 95% CI： 1.06-2.76, P =0.029], LAD [OR = 1.04, 95% CI： 1.01-1.08, P = 0. 025], revealed by Logistic regression analysis, were those independent predictors of RATs. Conclusions： RATs are com- mon during AF ablation. PCS, a history of RATs, persistent/permanent AF and LAD are those independent predictors of RATs.