影响CARTO指导下房颤/房扑导管消融疗效的相关因素分析

Related factors influencing curative effects of CARTO-guided catheter ablation on atrial fibrillation /atrial flutter

目的分析影响CARTO指导下房颤/房扑导管消融疗效的相关因素，为选择消融患者提供依据。方法对我科收治的100例行CARTO三维标测系统指导下导管消融的房颤/房扑患者进行6个月随访，根据是否维持窦律分为手术成功组（A组）与复发组（B组），对两组的临床资料进行回顾性分析。结果术毕阵发性房颤患者为窦性心律，持续性房颤患者转为窦性心律。经过6个月的随访，71例维持窦律，29例房颤/房扑复发。单因素回归分析显示：持续性房颤、升高的超敏C反应蛋白（hs-CRP）、升高的氮末端B型脑钠肽前体（NT-proBNP）、增大的最大左房校正容积（LAVImax）、中重度二尖瓣返流是房颤/房扑复发的危险因素（P＜0.05）。升高的hs-CRP（HR：5.12；95%CI： 1.87～14.06，P=0.002）与中重度二尖瓣返流（HR：3.35；95%CI： 1.27～8.84,P=0.015）是房颤/房扑复发的独立危险因素，复发风险分别为非暴露患者的5.12倍和3.35倍；ROC曲线分析显示hs-CRP作为独立危险因素的切点为3.41 mg/L。结论CARTO指导下导管消融术是治疗房颤/房扑的有效方法，升高的hs-CRP与中重度二尖瓣返流是房颤/房扑复发的独立危险因素，在拟行消融术患者的选择方面可考虑上述相关因素。

Objective To evaluate the related factors influencing the curative effects of CARTO-guided catheter ablation on atrial fibrillation/atrial flutter （AF/AFL） and to provide evidences for the selection of patients. Methods A retrospective analysis was carried out in 100 cases that were divided into 2 groups according to maintenance of sinus rhythm, effective group （group A） and AF/AFL recurrence group （group B）, after 6 months of follow-up. The clinical data of the 2 groups were analyzed. Results All patients showed sinus arrhythmia just after the catheter ablation. After 6 months of follow-up, there were 71 cases of sinus arrhythmia and 29 cases of AF/AFL recurrence. Persistent AF, increased hs-CRP level, increased NT-proBNP level, enlarged LAVImax and moderate and severe degree of mitral regurgitation were significantly associated with AF/AFL recurrence （P〈0.05）. Furthermore, increased hs-CRP level （HR：5.12；95%CI： 1.87-14.06, P=0.002） and moderate and severe degree of mitral regurgitation were independent predictors of AF/AFL recurrence. Conclusion Catheter ablation is an effective treatment of AF/AFL in guidance of CARTO. Considering baseline hs-CRP and mitral regurgitation before catheter ablation will improve the success rate.