导管射频消融阵发性心房颤动合并快慢综合征的疗效观察

Long-term clinical outcomes of catheter ablation in patients with atrial fibrillation predisposing to tachycardia-bradycardia syndrome

目的:探讨射频消融治疗阵发性心房颤动(房颤)合并快慢综合征患者的临床疗效。方法:2012年1月至2016年6月共入选150例阵发性房颤伴发作终止时长间歇≥3.0s的患者,拟行导管射频消融术后1、3、6、9、12个月随访常规心电图和动态心电图检查。结果:127例患者接受了心内电生理检查及射频消融术,平均RR长间歇为(4.3±1.0)s,9例患者在射频消融术后14d至31.5个月接受了永久起搏器置入术;与未接受永久起搏器置入术的患者相比,行永久起搏器置入的患者的最长RR间歇明显延长[(6.7±1.1)s对(4.2±0.7)s,P<0.01)];在调整了性别、年龄、病程、左室射血分数、左房内径等因素后,射频消融失败(OR=49.21,95%CI:7.28~332.51,P<0.001)、最长RR间歇≥6.5s(OR=7.32,95%CI:1.13~47.39,P=0.037)增加术后置入起搏器风险。结论:房颤发作抑制窦房结功能导致RR长间歇,射频消融治疗使窦房结功能有一定程度的恢复,但较长的RR间歇提示患者需接受永久起搏器置入治疗。

Objective：There is a controversy as to whether catheter ablation should be the first-line therapy for tachycardia-bradycardia syndrome（TBS）in patients with atrial fibrillation（AF）. Methods：A total of 150 patients with paroxysmal atrial fibrillation（PAF）and prolonged sinus pauses（≥3 s）on termination of AF were included in this study from January 2012 to June 2016.All the patients underwent electrocardiogram（ECG）and24 h Holter before the procedure,and at 1,3,6,9,12 months after catheter ablation. Results：One hundred and twenty-seven patients accepted intra cardiac electrophysiological study and catheter ablation with the mean pause of（4.3±1.0）s.9 received implantation of a permanent pacemaker after ablation within the interval of 14 days to 31.5 months.Length of pause on termination of AF was significantly greater in patients who received pacemaker implantation after ablation than those who underwent ablation only [（6.7±1.1）s vs.（4.2±0.7）s,P〈0.01）].In the logistic regression analysis,the failure of ablation correlated with a greater risk of implantation of a permanent pacemaker（OR=49.21,95%CI：7.28～332.51,P〈0.001）,and longer pause（≥6.5 s）after termination of AF was associated with the requirement to implant a permanent pacemaker after ablation（OR=7.32,95%CI：1.13～47.39,P=0.037）,after adjusting the risk factors such as age,sex,time of AF symptom onset,left ventricular ejection fraction and left atriumsize. Conclusions：This study suggests that transient sinus node dysfunction caused by PAF suppression is reversible when AF is cured by catheter ablation.However,longer pause on termination of AF predicts the need to implant a permanent pacemaker after catheter ablation.