环肺静脉隔离与抗心律失常药物治疗房颤的对比研究

Comparison of Circumferential Pulmonary Vein Isolation and Antiarrhythmic Drug Therapy for Atrial Fibrillation

目的:比较环肺静脉隔离和抗心律失常药物治疗心房颤动维持窦性心律的疗效。方法:选取402例房颤患者根据不同的治疗策略分为消融组(n=143)和药物组(n=259),其中阵发性房颤344例,持续性房颤58例。收集患者的基本资料,对其定期进行随访,以房颤复发为主要研究终点,采用Kaplan-Meier方法和Log-rank检验比较2组房颤复发在随访期内的累积复发率。应用Cox回归模型分析影响房颤复发的因素。结果:消融组维持窦性心律者82例(57.3%),总有效率为83.2%。药物组维持窦性心律者63例(24.3%),总有效率为50.2%。生存分析显示:消融组对窦律维持率高于药物组,差异有统计学意义(P<0.001)。多因素分析显示:消融治疗是影响房颤复发的保护因素(OR=0.395,P<0.001)。房颤病程长、左房内径大是影响房颤复发的独立危险因素(OR分别为1.024、1.048,P<0.05)。结论:环肺静脉隔离可显著减少房颤复发,使更多的患者维持窦性心律,优于抗心律失常药物治疗,是治疗房颤安全有效的方法。

Objective： To compare the clinical efficacy between circumferential pulmonary vein isolation （CPVI） and an- tiarrhythmic drug therapy （ADT） on sinus rhythm （SR） maintenance in patients with atrial fibrillation （AF）. Methods： Four hundred and two patients with AF were divided into two groups, CPVI group （n=143） and ADT group （n=259）. In these pa- tients, there were 344 cases with paroxysmal AF and 58 with persistent AF. The basic data were collected, and patients were regularly followed up after discharged. The primary end point was AF recurrence. The cumulative recurrence rate of AF recur- rence in the follow-up period was analyzed by Kaplan-Meier analysis and Log-rank test between two groups. Results： Eighty-two patients maintained SR in CPVI group （57.3%）. The total effective rate was 83.2%. Sixty-three patients main- tained SR in ADT group （24.3%）. The total effective rate was 50.2%. By Log-rank test and Kaplan-Meier analysis, a signifi- cantly higher rate of maintained SR was found in CPVI group than that of ADT group （P 〈 0.001）. The multivariate analysis showed that treatment strategies were protective factors affecting the recurrence of atrial fibrillation （OR = 0.395, P 〈 0.001）. It was found that AF duration and left atrial diameter were independent risk factors for the recurrence of AF （OR = 1.024 and 1.048, P 〈 0.05）. Conclusion： Circumferential pulmonary vein isolation is superior to antiarrhythmic drugs for preventing AF recurrence in patients with atrial fibrillation.