盐水灌注射频消融对心房颤动患者左房压力的影响以及术后发生高左房压的危险因素分析

The changes in left atrial pressure after open-irrigated radiofrequency catheter ablation of atrial fibrillation and the risk factors of high left atrial pressure after ablation

目的:比较心房颤动(房颤)患者经盐水灌注射频消融前后的左房压力(LAP)变化,分析盐水灌注射频消融对LAP的影响并探讨术后发生高LAP(LAP≥18 mmHg,1 mmHg=0.133 kPa)的危险因素。方法:连续纳入2017年5月-2017年9月住院行射频消融治疗的72例左室射血分数保留的房颤患者,分别在房间隔穿刺后即刻和消融结束撤出导管前测定LAP。采集患者一般临床资料和术前超声心动图参数,并记录术中盐水灌注量、液体总入量和手术时间。根据术后平均LAP将患者分为2组,高LAP组(LAP≥18 mmHg,16例)和LAP正常组(LAP<18 mmHg,56例)。结果:房颤患者消融前后LAP比较差异有统计学意义[(8.9±4.8) mmHg∶(13.1±5.5) mmHg,P<0.001]。术后高LAP组年龄[(68±9)岁∶(61±11)岁,P=0.035]、持续房颤比例(50.0%∶23.2%,P=0.038)、左房容积指数[(41.43±11.85) ml/m^2∶(34.83±9.63) ml/m^2,P=0.030]、BNP水平[183.5(71.5,363.5) ng/L∶90.0(39.0,137.0) ng/L,P=0.043]均显著高于LAP正常组。多因素Logistic回归分析显示年龄(OR=1.117,95%CI:1.023~1.220,P=0.014)和持续房颤(OR=6.424,95%CI:1.370~30.133,P=0.018)是术后发生高LAP的独立危险因素。结论:房颤患者经盐水灌注射频消融后LAP显著增加,高龄、持续房颤的患者术后发生高LAP的风险显著增加,需警惕术后早期急性心力衰竭的发生。

Objective:To evaluate the changes in left atrial pressure(LAP) after open-irrigated radiofrequency catheter ablation of atrial fibrillation(AF)and the risk factors of high LAP after ablation.Method:A total of 72 consecutive AF patients with preserved left ventricular ejection fraction admitted into our department to receive irrigated radiofrequency ablation from May 2017 to Sep 2017 were included and LAP was measured via transseptal sheath at the beginning and end of ablation procedures.We prospectively analyzed the clinical data,echocardiographic parameters,catheter irrigation and total volume load during ablation procedure,procedure duration.According to mean LAP after ablation,they were divided into two groups of high LAP(mean LAP≥18 mmHg,n=16)and normal LAP(mean LAP<18 mmHg,n=56).Result:Mean LAP significantly increased after ablation[(8.9±4.8)mmHg∶(13.1±5.5)mmHg,P<0.001].Age[(68±9)years∶(61±11)years,P=0.035],proportion of persistent AF(50.0%∶23.2%,P=0.038),left atrial volume index[(41.43±11.85)ml/m^2∶(34.83±9.63)ml/m^2,P=0.030],and BNP level[183.5(71.5,363.5)ng/L∶90.0(39.0,137.0)ng/L,P=0.043]were significantly higher in the high LAP group than in the normal LAP group.Multivariate logistic regression analysis revealed that age(OR=1.117,95%CI:1.023~1.220,P=0.014)and persistent AF(OR=6.424,95%CI:1.370~30.133,P=0.018)were independently correlated with the occurrence of high LAP after ablation.Conclusion:LAP significantly increased after open-irrigated radiofrequency ablation of AF.Older patients with persistent AF had a higher risk of high LAP after ablation.