不同猝死风险肥厚型心肌病合并房颤患者射频消融术后临床疗效对比

Efficacy and safety of radiofrequency catheter ablation in hypertrophic cardiomyopathy patients combined with atrial fibrillation with different risks of sudden cardiac death

目的:比较不同猝死风险的肥厚型心肌病(hypertrophic cardiomyopathy,HCM)合并心房颤动(atrial fibrillation,AF)患者进行导管射频消融的安全性和有效性。方法:从85例合并有AF的肥厚型心肌病患者中选取63例AF类型相匹配的患者。根据HCM Risk-SCD猝死风险预测模型,将63例HCM合并AF患者分为中高猝死风险组(n=18)和低猝死风险组(n=45)。收集两组患者的临床资料并比较导管射频消融的远期预后。结果:平均随访期为(41.7±36.4)个月。中高猝死风险组患者首次消融成功率明显低于低猝死风险组(22.2%vs 53.3%,P=0.021)。中高猝死风险组患者重复消融后远期预后差于低猝死风险组(33.3%vs 73.3%,P=0.003)。两组患者术后并发症及死亡率差异无统计学意义。多因素回归分析结果显示,左心房直径(OR=1.915,95%CI 1.071~3.445,P=0.006)和患者5年猝死风险(OR=2.901,95% CI 1.203~4.679,P=0.008)是消融术后复发的独立预测因素。结论:中高猝死风险HCM患者首次AF消融的有效性和重复消融的远期预后均差于低猝死风险HCM患者;对这些患者实施AF射频消融,尤其是重复消融应综合考虑手术风险及临床获益。

Objective： To compare the safety and efficacy of radiofrequency catheter ablation in hypertrophic cardiomyopathy（HCM）patients with atrial fibrillation（AF）with different risks of sudden cardiac death（SCD）.Methods：From 85 hypertrophic cardiomyopathy patients with AF,63 AF type-matched patients were selected.According to the HCM Risk-SCD risk prediction model,63 HCM patients combined with AF were divided into high-risk group（middle and high sudden death risk group,n=18）and low risk group（low sudden death risk group,n=45）.The clinical data of both groups of patients were collected and the long-term prognosis of radiofrequency catheter ablation was compared.Results：The mean follow-up period was（41.7±36.4） months.The successful rate of the first ablation in the high-risk group was significantly lower than that in the low-risk group（22.2%vs 53.3%,P=0.021）.The long-term prognosis after repeated ablation in the high-risk group was also worse than that in the low-risk group death（33.3%vs 73.3%,P=0.003）.There was no significant difference in postoperative complications and mortality between the two groups.Multivariate regression analysis showed that the left atrial diameter（OR=1.915,95%CI 1.071-3.445,P=0.006）and the 5-year SCD risk（OR=2.901,95% CI 1.203-4.679,P=0.008） were independent predictors on recurrence after ablation.Conclusions：The effectiveness of the first AF ablation and the long-term prognosis of repeated ablation in the HCM patients with high SCD risks are significantly lower than those in the HCM patients with low SCD risks.For them,AF radiofrequency ablation,especially repeated ablation,should be considered in combination with surgical risks and clinical benefits.