已达到消融终点的长程持续性心房颤动复发危险因素分析

Risk factors of atrial fibrillation recurrence in patients who obtained ablation endpoints with longstanding persistent atrial fibrillation

目的：探讨已达到消融终点的长程持续性心房颤动（房颤）患者复发的危险因素。方法：纳入达到消融终点的长程持续性房颤患者256例，消融终点定义为双侧肺静脉电隔离，二尖瓣峡部和左心房顶部线性消融双向阻断且碎裂电位消失。根据随访结果将患者分为房颤复发组（n＝43）和无复发组（n＝213）。通过多因素 COX 回归分析探讨房颤复发的独立危险因素。结果：经过（19．5±3．6）个月随访，与无复发组相比，房颤复发组患者右心房内径较大，为（53．31±6．55）mm 对（48．74±5．87）mm；房颤持续时间较长，为（81．83±45．75）个月对（53．16±40．23）个月；左心房内径较大，为（49．85±6．82）mm 对（46．77±5．83）mm，P 均＜0．01。多因素 COX 回归分析发现，左心房内径增大（OR＝1．01，95％CI：1．01～1．28，P ＜0．05），右心房内径增大（OR＝2．85，95％CI：1．15～7．03，P ＜0．05）、房颤持续时间延长（OR＝1．01，95％CI：1．01～1．02，P ＜0．05）是房颤复发的独立危险因素。结论：除左心房内径和房颤持续时间外，右心房内径增大也是已达到消融终点的长程持续性房颤复发的独立危险因素。

Objective：To investigate risk factors of atrial fibrillation （AF）recurrence in patients with long-standing persistent AF （LS-AF）who accepted catheter ablations and obtained current ablation endpoints. Methods：Two hundred and fifty-six LS-AF patients who accepted catheter ablations and obtained ablation endpoints were enrolled in this study.The current ablation endpoints were defined as complete pulmonary vein isolation,bidirectional block of lines and disappearance of complex fractionated atrial electrograms.According to the outcomes of follow-up,patients were classified as recurrence group （n=43）and non recurrence group （n =213）.The multivariate analysis was performed to identify the independent predictors of AF recurrence. Results：After （19.5±3.6）months of follow-up,patients in AF recurrence group had larger right atrium （RA）diameter,（53.31± 6.55）mm vs （48.74 ±5.87）mm ,longer AF duration,（81.83 ± 45.75）months vs （53.16 ± 40.23）months and larger left atrium （LA）diameter （49.85 ± 6.82）mm vs （46.77 ± 5.83）mm.Multivariate analysis showed that,larger RA diameter （OR=2.85,95%CI：1.15～7.03,P 〈0.05）,larger LA diameter （OR=1.01,95%CI：1.01 ～1.28,P 〈0.05）and longer AF duration （OR = 1.01,95% CI：1.01 ～ 1.02,P 〈 0.05 ）were independent predictors of AF recurrence. Conclusion：In addition to larger LA diameter and longer AF duration,langer RA diameter is an independent predictor of AF recurrence in LS-AF patients who obtained ablation endpoints.