影响心房颤动冷冻球囊消融治疗后电复律成功率的相关因素分析

Analysis of related factors influencing the success rate of electrical cardioversion in patients with atrial fibrillation after cryoballoon ablation

目的:探讨影响心房颤动(房颤)冷冻球囊消融治疗后电复律成功率的相关因素。方法:连续入选2017年1月至2018年9月在中国医学科学院阜外医院心律失常中心接受第二代冷冻球囊消融治疗的症状性房颤患者935例,需电复律治疗的房颤患者为217例,其中4例患者因除颤电极贴与皮肤粘合不紧密导致电复律失败排除入选,根据电复律结果分为电复律成功组192例和电复律失败组21例,对其相关临床因素变量进行统计分析,包括:年龄、性别、身高、体重、体重指数(BMI)、房颤类型、房颤病程、合并基础疾病、左心房直径、左心室直径、射血分数、抗心律失常药物、抗凝药物以及C反应蛋白等指标。结果:入组患者首次电复律成功率为90.1%,最终电复律成功率为96.2%。与电复律成功组的患者相比,电复律失败组的患者阵发性房颤、合并糖尿病、未服胺碘酮药物的比例更大,并且体重、BMI、C反应蛋白较前者明显升高( P < 0.05)。多因素回归分析发现,阵发性房颤( OR=11.419,95% CI 2.497~52.217, P=0.002)、BMI过高( OR=1.106,95% CI 0.718~1.174, P=0.022)、合并糖尿病( OR=4.331,95% CI 1.174~15.977, P=0.028)以及C反应蛋白升高( OR=1.256,95% CI 1.030~ 1.924, P =0.009),与房颤冷冻球囊消融治疗后电复律的成功率呈负相关( P<0.05)。 结论:对于房颤冷冻球囊消融治疗后仍为房颤的患者,直流电复律是一种有效恢复窦性心律的方法,并且阵发性房颤、BMI过高、合并糖尿病以及C反应蛋白升高是影响此类房颤电复律成功率的独立预测因素。

Objective The purpose of this study was to investigate the related factors affecting the success rate of electrical cardioversion in patients with atrial fibrillation after cryoballoon ablation.Methods From January 2017 to September 2018,a total of 935 patients with symptomatic atrial fibrillation who underwent second-generation cryoballoon catheter ablation at the Fuwai Hospital were enrolled,and 217 patients with atrial fibrillation who underwent the electrical cardioversion,4 patients were excluded for inadequate contact between adhesive patches and skins,according to the results of electrical cardioversion,the patients were divided into the successful cardioversion group(192 cases)and unsuccessful cardioversion group(21cases),and the relevant clinical factors were analyzed,including:age,gender,height,weight,body mass index,type of atrial fibrillation,duration of atrial fibrillation,concomitant basic disease,left atrial diameter,left ventricular diameter,ejection fraction,use of antiarrhythmic drugs,anticoagulant drugs,and level of C-reactive protein.Results The success rate of electrical cardioversion was 90.1%(initial shock),and 96.2%(final shock),respectively.Compared With patients in the successful cardioversion group,the patients in the failed group had more proportion of paroxysmal atrial fibrillation,diabetes and no amiodarone and their body weight,body mass index,and level of C-reactive protein were significantly higher than those in the former group(P<0.05).Multivariate regression analysis showed that patients with paroxysmal atrial fibrillation(OR=11.419,95%CI 2.497~52.217,P=0.002),high body mass index(OR=1.106,95%CI 0.718~1.174,P=0.022),diabetes(OR=4.331,95%CI1.174~15.977,P=0.028)and elevated C-reactive protein(OR=1.256,95%CI 1.030~1.924,P=0.009)were negatively correlated with successful rate of electrical cardioversion(P<0.05).Conclusions For those patients which were still atrial fibrillation after undergoing cryoballoon ablation,electrical cardioversion was an effective method of restoring normal sinus rhythm,and paroxysmal atrial fibrillation,high body mass index,diabetes,and elevated C-reactive protein were independent predictor of unsuccessful electrical cardioversion.