右心房大小不能预测持续性心房颤动导管射频消融术后的复发

Size of right atrial fails to predict arrhythmia recurrence after catheter ablation of persistent atrial fibrillation

目的：本研究旨在探讨右心房横径（RAD）是否可以预测持续性心房颤动射频消融术后复发。方法：纳入2009年1月至2011年12月,在北京安贞医院行导管射频消融术的持续性心房颤动患者共274例。消融策略为双侧环肺静脉隔离（PVI）基础上加行左心房顶部、二尖瓣峡部和三尖瓣峡部线性消融。术后以常规心电图和动态心电图随访患者心律失常复发情况。运用回归分析方法甄别与心律失常复发相关的危险因素并检测其预测效力。结果：术后随访平均24个月,共有174例消融术后复发。与未复发组相比,复发组左心房内径（LAD）显著性增大[（44.6±5.4）vs.（42.8±5.8）mm;P=0.009],但是两组的RAD差异无统计学意义,[（43.5±5.6）vs.（43.7±6.1）mm;P=0.796）。单因素Cox回归分析显示女性（HR=0.475,95%CI：0.260-0.867,P=0.015）﹑体质量指数（HR=1.063,95%CI：0.988-1.143,P=0.100）和LAD（HR=1.064,95%CI：1.015-1.115,P=0.010）是心房颤动术后复发的危险因素,而RAD不是心房颤动术后复发的危险因素。多因素Cox回归分析显示LAD（HR=1.053,95%CI：1.000-1.109,P=0.050）和女性（HR=0.418,95%CI：0.213-0.819,P=0.011）可以独立预测心房颤动消融术后复发。结论：右心房大小不能独立预测持续性心房颤动消融术后复发,推测有其他潜在的机制参与此类心房颤动的发生与维持。

Objective：This study is to determine whether right atrium diameter（RAD） could predict arrhythmia recurrence after catheter ablation of persistent AF. Methods ： 274 consecutive patients with persistent AF who underwent primary ablation at Beijing Anzhen hospital were enrolled. Ablation strategy included bilateral pulmonary vein isolation （PVI） plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations. Atrial taehyarrhythmia recurrence was followed-up by means of ECG and Hoher monitoring. Risk factors associated with arrhythmia recurrence were determined by a Cox regression model. Results： After （24 ± 18） months＇ follow-up, 174 patients experienced atrial tachyarrhythmia recurrence. Patients with recurrence had larger LAD [ （44. 6 ±5.4）vs. （42. 8 ±5.8） mm, P =0. 009] but similar RAD [ （43.5±5.6 ）vs. （43.7±6. 1）mm,P = 0. 7961 as those of patients without arrhythmia recurrence. Univariate Cox regression analysis demonstrated that female gender （ HR = 0. 475, 95% CI 0. 260-0. 867, P = 0. 015 ）, Body mass index （ HR = 1. 063, 95% CIO. 988-1.143, P = O. 100 ） and LAD （ HR = 1. 064, 95 % CI1. O15-1.115, P = 0. 010 ） were risk factors of recurrence after AF ablation. Multivariate Coxregression analysis showed that LAD （HR = 1. 053, 95% CI 1. 000- 1. 109, P =0. 050） and female gender （HR = 0. 418, 95% CIO. 213-0. 819, P = 0. 011 ） was an independent predictor of arrhythmia recurrence following catheter ablation of persistent AF in this subset of patients. Conclusion： RAD is not a risk factor of arrhythmia recurrence after catheter ablation of persistent AF, which refleets the difference in underlying mechanism of AF initiation and AF maintenance.