碎裂QRS波预测肥厚型心肌病合并心房颤动患者射频消融术后心律失常复发的探讨

Fragmented QRS predicts arrhythmia recurrence after catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy

目的:探讨碎裂QRS波(f QRS)与肥厚型心肌病(HCM)合并心房颤动患者导管消融术后的复发是否有关。方法:纳入在北京安贞医院行导管消融术的HCM合并心房颤动患者共91例(阵发/持续性心房颤动:60/31)。消融策略包括:阵发性心房颤动患者行双侧肺静脉隔离(PVI);持续性心房颤动患者行PVI加左心房顶、二尖瓣峡部和三尖瓣峡部线性消融。术前评估基线心电图,fQRS定义为常规12导联心电图中至少2个连续导联的QRS波存在≥2个R波或者R波的波顶或S波的波谷出现顿挫波。术后定期随访,复发定义为导管消融术后心电图或动态心电图记录的任何类型的>30s的房性快速性心律失常。结果 68.1%(62/91)患者fQRS阳性。fQRS最常见于下壁导联(75.8%)。平均随访18个月,窦性心律维持率为54.2%(59/91),74.6%(44/59)复发发生在1年以内。fQRS阳性组复发率高于fQRS阴性组(79.0%vs.34.5%,P<0.001)。多因素Cox回归分析表明,fQRS是术后快速房性心律失常复发的危险因素(HR=3.243,95%CI:1.147~9.167,P=0.026)。结论:fQRS是HCM合并心房颤动患者导管消融术后房性心律失常复发的预测因子,可用于预测该类患者心房颤动射频术后转归。

Objective：This study is to investigate whether fQRS is associated with arrhythmia recurrence after catheter ablation of AF in hypertrophic cardiomyopathy（HCM）patients.Methods：91 HCM patients who underwent primary AF ablation at Beijing Anzhen hospital were enrolled.Ablation strategy included bilateral pulmonary vein isolation（PVI）for paroxysmal AF（n=60）and PVI plus left atrial roof,mitral isthmus and tricuspid isthmus linear ablations for persistent AF（n=31）.Baseline ECG was reviewed prior to index procedure and fQRS was defined as notching of the R or S wave in 2 contiguous ECG leads.Arrhythmia recurrence was defined as any kind of post-procedural atrial tachyarrhythmia of30s documented by ECG or Holter.Results：fQRS was present in 62（68.1%）patients at baseline.fQRS was most commonly observed in inferior lead（75.8%）.After an average of 18 months’follow-up,59 patients experienced arrhythmia recurrence with most recurrence（44/59,74.6%）occurred within 1 year.Arrhythmia recurrence rate in the fQRS（＋）group（79.0%,49/62）was higher than that in the fQRS（-）group（34.5%,10/29;P〈0.001）after single procedure.Multivariate COX regression demonstrated that fQRS was an independent risk factor of recurrence（HR=3.243,95%CI：1.147-9.167,P=0.026）.Conclusion：fQRS is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation,and could be useful for identifying those patients likely to have a better outcome following the procedure.