代谢综合征对长程持续性心房颤动导管消融复发风险影响的研究

Metabolic syndrome and risk of recurrence after catheter ablation of long-standing persistent atrial fibrillation

目的 探讨代谢综合征对长程持续性心房颤动（房颤）导管消融成功率的影响.方法 回顾性分析2009年3月至2010年5月人院因持续性房颤初次导管消融的248例患者的临床资料,248例中男197例、女51例,年龄（56±12）岁.房颤持续时间1年以上归为长程持续性房颤组,持续时间短于1年的归为非长程持续性房颤组.结果 248例患者中代谢综合征96例（38.7％）,长程持续性房颤130例（52.4％）.随访91～1 222（404±303）d,119例（47.9％）复发,代谢综合征组复发率为58.3％,非代谢综合征组复发率为41.4％（P=0.017）.长程持续性房颤中代谢综合征患者48例（36.9％）,非长程持续性房颤中代谢综合征48例（40.7％）,两组代谢综合征的患病率差异无统计学意义（P=0.544）.长程持续性房颤代谢综合征组复发率60.4％,非代谢综合征组复发率48.8％（P=0.177）;非长程持续性房颤代谢综合征组复发率56.3％,非代谢综合征组复发率32.9％（P=0.033）.多因素分析显示,代谢综合征（风险比1.98,95％ CI1.04 ～ 3.76,P=0.036）、房颤病程（风险比1.04,95％CI1.01～1.07,P=0.004）是导管消融复发的独立危险因素,长程持续性房颤不是导管消融复发的独立危险因素.结论 代谢综合征影响非长程持续性房颤导管消融成功率,但对长程持续性房颤导管消融成功率无显著影响.

Objective This study sought to explore the impact of metabolic syndrome （MS） on the risk of recurrence after catheter ablation of long-standing persistent atrial fibrillation （AF）.Methods Totally 248 patients [197 male,（56 ± 12）years] with persistent AF and catheter ablation were included.Long-standing persistent AF was defined based on the duration （more than one year）.Results Among the 248 patients,96 （38.7%） patients had MS,130 （52.4%） patients had long-standing persistent AF.After 91-1222（404 ±303） days follow-up,119 （47.9%） had recurrence.The recurrence rate was significantly higher in the MS group than that in the non-MS group （58.3% vs 41.4%,P =0.017）.The proportion of MS was similar between the long-standing persistent AF group and the non-long-standing persistent AF group （36.9% vs 40.7%,P =0.544）.Subjects with MS had higher recurrence rate than those without MS in non-long-standing AF group （56.3% vs 32.9%,P =0.033）,but not in long-standing AF group （60.4% vs 48.8%,P =0.177）.In multivariate analysis,MS （hazard ratio 1.98,95% CI 1.04-3.76,P =0.036） and AF history duration （hazard ratio 1.04,95% CI 1.01-1.07,P =0.004） were independent risk factors for recurrence after catheter ablation of AF.Long-standing persistent AF was not an independent risk factor of recurrence.Conclusion MS was natively associated with the success rate of catheter ablation of AF in patients with non-long-standing persistent AF,but not in patients with long-standing persistent AF.