心房颤动射频消融术后高度心房间传导阻滞对预测复发的价值

Predictive value of advanced interatrial block to relapse of atrial fibrillation after radiofrequency catheter ablation

目的探讨高度心房间传导阻滞(a-IAB)与心房颤动(房颤)经导管射频消融术后复发的相关性。方法选取2017年至2018年于武汉大学人民医院心血管内科首次行经导管射频消融术的206例房颤患者。根据随访结果将患者分为复发组(n=62)和未复发组(n=144)。比较两组患者的一般临床资料及生化检验结果等。结果在本研究中,阵发性房颤138例(67%),持续性房颤68例(33%)。复发组与未复发组患者相比,房颤病程更长[(49.3±28.3)vs.(39.5±26.8),P=0.019],P波间期更长[(113.5±14.2)vs.(108.8±14.0),P=0.026];左心房直径更大[(42.0±4.8)vs.(39.0±4.6),P<0.001],a-IAB所占比例更高[24(38.7%)vs.20(14%),P<0.001]。多因素Logistics回归分析结果显示,a-IAB[3.519(1.175~10.537),P=0.025],左心房直径[1.138(1.056~1.2226),P=0.001]为房颤复发的独立危险因素。结论经导管射频消融术后房颤的复发与a-IAB密切相关,a-IAB和左心房直径能够独立预测术后房颤的复发。

Objective To investigate the correlation between advanced interatrial block(a-IAB)and relapse of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods AF patients(n=206)with RFCA for the first time were chosen from Department of Cardiology in Renmin Hospital of Wuhan University from 2017 to 2018.All patients were divided,according to follow-up results,into relapse group(n=62)and non-relapse group(n=144).The general data and biochemical test results were compared between 2 groups.Results There were 138 cases(67%)of paroxysmal atrial fibrillation(PAF)and 68(33%)of persistent atrial fibrillation(PeAF).Compared with non-relapse group,in relapse group AF course was longer[(49.3±28.3)vs.(39.5±26.8),P=0.019],P-wave interval was longer[(113.5±14.2)vs.(108.8±14.0),P=0.026],left atrial diameter(LAD)was longer[(42.0±4.8)vs.(39.0±4.6),P<0.001],and percentage of a-IAB cases was higher[24(38.7%)vs.20(14%),P<0.001].The results of multi-factor Logistics regression analysis showed that a-IAB[3.519(1.175~10.537),P=0.025]and LAD[1.138(1.056~1.2226),P=0.001]were independent risk factors of AF relapse.Conclusion The relapse of AF after RFCA is closely correlated to a-IAB,and a-IAB and LAD can independently predict AF relapse after RFCA.