阵发性心房颤动患者环肺静脉消融疗效及空白期房性心律失常对术后复发的预测价值

Effect of CPVA in paroxysmal AF patients and value of atrial arrhythmia in predicting the recurrence of AF

目的探讨三维标测系统指导下阵发性心房颤动(房颤)患者环肺静脉线性消融疗效及空白期房性心律失常对术后复发的预测价值。方法选择60例阵发性房颤患者,均进行双侧环肺静脉线性消融治疗,术后长期观察和随访,对比观察空白早期(术后1个月)、空白晚期(术后2~3个月)和空白期后(>3个月)房性心律失常复发情况。结果 60例患者均成功进行环肺静脉隔离,仅1例术中发生迷走反射。空白早期复发房颤20例,空白期后有13例未再发作;空白晚期复发房颤17例,空白期后有16例仍发作。空白晚期复发预测术后复发敏感性、特异性、阳性预测值、阴性预测值和准确性均较空白早期高(88.9%vs 38.9%、97.6%vs 69.0%、94.1%vs 35.0%、95.3%vs72.5%和95.0%vs 60.0%)。18例复发患者中,发作时症状明显患者较术前减少(33.3%vs 88.9%),抗心律失常药物治疗有效患者较术前增加(66.7%vs 16.7%),房颤发作频度下降,持续时间缩短(P<0.05)。结论三维标测系统指导下对阵发性房颤患者环肺静脉消融治疗安全有效,空白晚期复发预测房颤消融术后复发的价值较高。

Objective To study the effect of 3D mapping system-guided CPVA in paroxysmal AF patients and the value of atrial arrhythmia in predicting the recurrence of AF.Methods Sixty paroxysmal AF patients who received bilateral CPVA therapy were followed up,during which the recurrence of AF was observed in early blank period（1month after CPVA）,late blank period（2-3months after CPVA）and post blank period（3months after CPVA）.Results The CPVA was successful in 60 patients except vagal reflex in 1patient.AF recurred in 20 patients during the early blank period,did not recur in 13 patients during the post balnk period,recurred in 17 patients during the late blank period and in 16 patients during the post blank period.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of atrial arrhythmia in predicting the recurrence of AF after CPVA were significantly higher in late blank period than in early blank period（88.9%vs 38.9%,97.6%vs 69.0%,94.1%vs 35.0%,95.3%vs 72.5%,95.0%vs 60.0%,P〈0.05）.The incidence of symptoms was significantly lower in 13 patients at the onset of AF than before CPVA and was significantly higher in 13 patients after treatment with antiarrhythmic drugs than before CPVA（33.3%vs 88.9%,66.7%vs 16.7%,P〈0.05）.The incidence of AF was lower and its persistent time was longer（P〈0.05）.Conclusion 3D mapping system-guided CPVA is safe and effective in paroxysmal AF patients.Atrial arrhythmia can effectively predict the recurrence of AF in late blank period after CPVA.