心房颤动患者CHADS2评分与导管消融术远期疗效的关系

Association between CHADS2 score and long-term atrial fibrillation recurrence rate after catheter ablation

目的 探讨影响心房颤动（房颤）患者导管消融术后远期（3年以上）疗效及其相关因素.方法 随访2004年1月至2009年3月间在上海薪华医院心内科行单次导管消融术房颤患者,术后门诊定期常规心电图及24 h动态心电图检查,电话及门诊随访并记录结果与时间.房颤复发定义为：患者在空白期（术后3个月）以后的随访期内心电图和（或）24 h动态心电图记录房性心律失常[房颤、心房扑动（房扑）、房性心动过速（房速）]持续时间≥30 s.Cox多因素回归分析其术前基础疾病、CHADS2评分（有慢性心力衰竭、高血压、年龄≥75岁、糖尿病各计1分,既往有卒中或短暂性脑缺血发作计2分）等与术后远期结果的关系.结果 入选280例患者,50例失访,3例死亡,取得有效数据227例（男性132例,女性95例）,随访时间为51（41,56）个月,其中复发109例,房颤消融术后≥3年的总复发率为48.0％（109/227）.多因素Cox回归分析显示高CHADS2评分（HR：1.417,95％ CI1.194～1.682,P＜0.001）与房颤消融未终止（HR：2.077,95％ CI：1.380～3.126,P=0.043）是房颤消融术后复发的预测因素.房颤消融终止组复发率为41.0％ （75/183）,而消融未终止组复发率则高达77.3％（34/44）.在消融终止组中,CHADS2评分≥3分的患者复发率为80.0％ （12/15）,中位房颤无复发期为12个月.在术中消融未终止组：CHADS2评分=0分房颤患者,复发率为60.0％ （6/10）,中位无复发期为30个月;CHADS2评分=1～2分房颤患者,复发率为77.8％ （21/27）,其中位无复发期为12个月;CHADS2评分≥3分患者,复发率100％ （7/7）,中位无复发期仅为6个月,且在2年内全部复发.结论 房颤患者术前CHADS2评分是房颤患者消融术后复发的预测因素.患者术前CHADS2评分越高,其复发率也越高,中位无复发期也越短.

Objective To investigate the association between CHADS2 score and long-term （≥ 3years） outcomes post catheter ablation in patients with atrial fibrillation （AF）.Methods AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up.AF recurrence was defined as the occurrence of atrial arrhythmias （AF,atrial flutter and atrial tachycardia） recorded by electrocardiogram monitor （≥ 30seconds） after ablation during follow-up period （after 3 months blanking period）.The relationship between baseline clinical and echocardiographic characteristics and the time to recurrence during follow-up was evaluated using Cox multivariate analysis.Results A total of 280 patients who received single catheter ablation procedure were included in the study,3 patients died and there were 50 patients lost to follow-up.A total of 227 patients with AF （163 paroxysmal and 64 non-paroxysmal） were enrolled in the final analysis.During a median follow-up of 51 months （41-56 months）,109 patients experienced AF recurrences and the recurrence rate after catheter ablation （≥3 years） was 48.0％ （109/227）.Cox multivariate analysis showed that the high CHADS2 score （HR：1.417,95％ CI 1.194-1.682,P ＜0.001） and AF nontermination during ablation （HR：2.077,95％ CI 1.380-3.126,P =0.043） were risk factors of AF recurrence.AF recurrence rates in the termination and non-termination group were 41.0％ （75/183） and 77.3％ （34/44）,respectively.In the AF termination group,the recurrence rates and the median recurrence free time in patients with CHADS2 score≥3 were 80.0％ （12/15） and 1 year,respectively.In the non-AF termination group,the recurrence rates in patients with CHADS2 score =0,CHADS2 score =1-2 and CHADS2 score≥3 were 60.0％ （6/10）,77.8％ （21/27） and 100％ （7/7）,respectively; the median recurrence free time of patients with CHADS2 score =0,CHADS2 score =1-2 and CHADS2 score ≥3 were 30 months,12 months and 6 months,respectively.Conclusions CHADS2 score is a predictor of AF recurrences after catheter ablation.Patients with high CHADS2 score is associated with higher risk of longterm （≥3 years） AF recurrences.