肥胖患者阵发性心房颤动环肺静脉电隔离术后的预后研究

The prognosis of circumferential pulmonary vein isolation of paroxysmal atrial fibrillation in obese patients

目的评价肥胖患者阵发性心房颤动(房颤)环肺静脉电隔离术后的疗效及预后。方法入选2012年1月~2014年12月在我院首次行导管消融治疗的肥胖阵发性房颤患者70例(体重指数BMI≥28 kg/m2,肥胖组),同期选择按性别、年龄、房颤病程、基础疾病、CHA2DS2-VASc评分、左心房内径、左心室射血分数匹配的70例正常BMI的阵发性房颤患者(18.5≤BMI<24 kg/m^2,正常组)。两组均采用环肺静脉电隔离术式治疗。术后随访12个月,比较肥胖组与正常组的复发率,并探讨肥胖对术后复发的影响。结果术后随访12个月,肥胖组的复发率高于正常组(27.1%vs 12.9%,P<0.05)。单因素和多因素分析均显示高BMI、扩大的左心房内径是阵发性房颤导管消融术后复发的独立危险因子(P均<0.05)。结论肥胖患者阵发性房颤导管消融治疗是有效的。肥胖、左心房扩大是术后复发的独立危险因素。

Objective To evaluate the efficacy and prognosis of circumferential pulmonary vein isolation of paroxysmal atrial fibrillation in obese patients.Methods A total of 70 obese patients with paroxysmal atrial fibrillation who had undergone catheter ablation for the first time in our hospital from January 2012 to December 2014 were included(body mass index BMI≥28 kg/m2,obese group).And 70 paroxysmal AF patients with normal BMI in the same period were matched according to gender,age,the course of atrial fibrillation,underlying disease,CHA2DS2-VASc score,left atrial diameter and left ventricular ejection fraction(18.5≤BMI<24 kg/m2,normal group).Both groups were treated with circumferential pulmonary vein isolation.After 12 months of follow-up,the recurrence rates of the obese and normal groups were compared,and the effect of obesity on postoperative recurrence was explored.Results After 12 months of follow-up,the recurrence rate of the obese group was higher than that of the normal group(27.1%vs 12.9%,P<0.05).Both univariate and multivariate analysis showed that high BMI and enlarged left atrial diameter were independent risk factors for recurrence after catheter ablation of paroxysmal atrial fibrillation(P all<0.05).Conclusion Catheter ablation of paroxysmal atrial fibrillation in obese patients is effective.And obesity and left atrial enlargement are independent risk factors for postoperative recurrence.