左心房压力对心房颤动射频消融术后复发的预测意义

Predictive significance of left atrial pressure in the recurrence of atrial fibrillation after radiofrequency ablation

目的观察心房颤动(房颤)患者射频消融前的左心房压力(LAP),分析LAP与术后房颤复发的关系,为未来预测房颤复发的提供依据。方法选择2018年6月至2019年8月顺利完成射频消融术治疗的100例房颤患者作为研究对象,统计患者一般资料,包括性别、年龄、体重指数(BMI)、病程、房颤类型、左心房直径(LAD)、左心室射血分数(LVEF)、二尖瓣舒张早期血流峰速度与二尖瓣环舒张早期运动峰速度比值(E/e’)及有无高血压、冠心病、卒中史、糖尿病、高脂血症等基本情况;手术开始后于射频消融之前测定患者的LAP;记录患者出院后6个月内复发情况,分析房颤患者射频消融术后复发的影响因素,评估LAP预测术后复发的效能。结果为期6个月的随访调查发现,100例房颤射频消融术患者中,14例复发,复发率为14.00%;单因素分析发现,性别、高血压、冠心病、卒中史、糖尿病、高脂血症、年龄、BMI、病程、LVEF、E/e’对术后复发无影响(P>0.05),房颤类型、LAD、LAP对术后复发可能有影响(P<0.05);多因素Logistic回归分析发现,持续性房颤、LAD增大、LAP增大是术后复发的影响因素(OR>1,P<0.05);ROC曲线分析发现,LAP预测术后复发的AUC=0.880,预测效能高。结论持续性房颤患者射频消融术后仍有较高的复发风险,可能与患者LAD、LAP增大有关,且以LAP增大带来的影响最为显著,可考虑将其作为预测持续性房颤患者射频消融术后复发的关键指标。

Objective To investigate left atrial pressure(LAP)before radiofrequency ablation in patients with atrial fibrillation(AF),and to analyze the correlation between LAP and postoperative recurrence of AF,so as to provide a basis for predicting future recurrence of AF.Methods One hundred patients with atrial fibrillation who were treated by radiofrequency ablation successfully in our hospital from June 2018 to August 2019 were enrolled in the study.The general data including patient’s gender and age,body mass index(BMI),disease duration,type of atrial fibrillation,left atrial diameter(LAD),left ventricular ejection fraction(LVEF),ratio of peak blood flow velocity during early mitral valve diastole to peak velocity during early mitral valve annulus relaxation(E/e’)and the basic disease history of hypertension,coronary heart disease,stroke history,diabetes,hyperlipidemia were observed and compared between the two groups.Moreover the influencing factors of recurrence after radiofrequency ablation and the efficacy of LAP in predicting postoperative relapse were analyzed.Results After 6-month follow up,of the 100 patients,there were 14 cases of relapse,with the recurrence rate being 14.00%.Univariate analysis showed that gender,hypertension,coronary heart disease,stroke history,diabetes,hyperlipidemia,age,BMI,course of disease,LVEF,E/e’had no effects on postoperative recurrence(P>0.05),however,the atrial fibrillation type,LAD,LAP had effects on postoperative recurrence(P<0.05).Multivariate logistic regression analysis showed that persistent atrial fibrillation,increased LAD,and increased LAP were influencing factors for postoperative recurrence(P<0.05).In addition the ROC curve analysis found that the AUC of LAP in predicting postoperative recurrence was 0.880,which had higher predictive efficacy.Conclusion The patients with persistent atrial fibrillation have higher risk of recurrence after radiofrequency ablation,which may be related to the increase of LAD and LAP,moreover,the effects of LAP are the most significant,which can be regarded as a key index for predicting recurrence after radiofrequency ablation.