房间阻滞对心脏再同步治疗后新发心房颤动的影响

Influence of intra-atrial block on the incidence of new onset atrial fibrillation after cardiac resynchroni- zation therapy

目的评价房间阻滞对心脏再同步治疗（CRT）术后新发心房颤动（房颤）的影响。方法69例接受心脏再同步治疗除颤器（CRT—D）的慢性心力衰竭患者根据体表心电图I导联或aVL导联或V1导联P波时限及形态，分为：房间阻滞组（17例）、房间传导正常组（52例）。术后1、3、6、12个月随访，复查超声心动图（UCG）及24h动态心电图（DCG），并根据患者术后心功能改善情况决定是否接受超声指导下起搏器优化。结果与房间传导正常组相比，房间阻滞组新发房颤率（41．1％对11．5％，P=0．012）明显增高，而且大多数患者在术后早期（术后1周）即出现新发房颤。此外，房间阻滞组超声指导下起搏器优化率（41．1％对11．5％，P：0．012）也明显增高，并且需要更长的AV／PV问期。结论房间阻滞增加CRT-D术后新发房颤的风险。

Objective The purpose of this study was to evaluate the influence of intra-atrial block （IAB） on the incidence of new onset atrial fibrillation after cardiac resynchronization therapy（CRT）. Methods Sixty-nine patients with chronic heart failure underwent cardiac resynchronization therapy defibrillator（CRT-D） were divided into lAB group and non-lAB group according to the P-wave duration and morphology in lead I, lead aVL or lead V1 of electrocardiogram, lAB group： P-wave duration ≥ 120 ms or the distance between two peaks in P-wave（Pd）≥40 ms;non-lAB group：P-wave duration〈120 ms and Pd〈40 ms.UCG and DCG were repeated respectively in 1,3,6,12 months after CRT-D.Whether the patient needs to accept a pacemaker opti- mization guided by echocardiography depended on the patient＇ s heart function. Results After 12 months fol- low-up, compared with the non-lAB group, the incidence of new onset atrial fibrillation after CRT-D in lAB group increased obviously（ 41.1% vs 11.5% ,P= 0. 012） , and most of new onset atrial fibrillation were found in the early stage（ within one week）after CRT-D. Furthermore ,the rate of pacemaker optimization guided by echo- cardiography in IAB group increased significantly（ 41.1% vs 11.5%, P = 0. 012）, and a longer AV/PV delay was needed in the patients in lAB group. Conclusion IAB increases the risk of new onset atrial fibrillation af- ter CRT-D.