导管消融对阵发性心房颤动患者抑郁和焦虑状态及生活质量的影响

Depression,anxiety,and quality of life after catheter ablation of paroxysmal atrial fibrillation

目的对比研究阵发性心房颤动(简称房颤)患者导管消融和药物治疗前后抑郁、焦虑状态和生活质量的变化。方法比较阵发性房颤导管消融和药物治疗基线和随访3、6、9、12个月时SF-36健康调查量表、抑郁自评量表和焦虑自评量表积分。结果连续入选接受导管消融治疗的阵发性房颤患者82例(导管消融组),同时入选抗心律失常药物治疗组84例(药物治疗组),两组在基线时社会人口统计学和临床特征方面无显著性差异。导管消融组中分别有42.7%和37.8%存在抑郁和焦虑,与对照组相比无显著性差异。两组躯体和精神状态积分均下降且组间无差异。导管消融组术后抑郁和焦虑自评量表积分明显减小,生活质量评分显著提高,P均<0.001。12个月时导管消融组72.0%维持窦性心律,明显高于药物治疗组(20%),P<0.001。除导管消融外,维持窦性心律和避免服用华法林是抑郁和焦虑状态改善,生活质量提高的独立预测因素。结论与抗心律失常药物治疗相比,导管消融能够更好地改善阵发性房颤患者的抑郁、焦虑状态和生活质量。

Objective To determine how depression, anxiety, and quality of life（QoL） changed after catheter ablation in patients with paroxysmal atrial fibrillation（AF）. Methods Eighty two consecutive patients with symptomatic paroxysmal AF who underwent catheter ablation （ablation group） were enrolled to compare with 84 analogous patients who received antiarrhythmic drug （AAD） therapy （AAD group）. The Self-rating Depression Scale （SDS）, the Self-rating Anxiety Scale （SAS）, and the Medical Outcomes Survey Short-Form （SF-36） questionnaires were completed at baseline and 3, 6, 9 and 12-month follow-up. Results At baseline, patients among two treatment groups were well matched in socio-demographic and clinical characteristics. Symptoms of depression and anxiety prevailed in 42.7% and 37.8% in the ablation group, with no significant differences from AAD group. Both groups similarly displayed reduced physical and mental QoL （ P〉0. 05 ）. Catheter ablation was an effective procedure in reducing depression （P〈0. 001 ） and anxiety （P〈0. 001 ） and improving QoL （P〈0. 001 ）, which was superior to AAD therapy. At 12 months, the prevalence of sinus rhythm was 72.0% in the ablation group, which was significantly higher than that in the AAD group （P〈O. 001）. The maintenance of sinus rhythm and free of warfarin use provided the contribution to improvements of depression, anxiety, and QoL besides catheter ablation （ all P〈0.01 ）. Conclusion Compared with AAD therapy, catheter ablation could improve depression, anxiety, and QoL effectively in patients with paroxysmal AF.