预激综合征合并阵发性心房颤动患者旁路射频消融术后心房颤动再发的危险因素分析

Risk factors of atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome and paroxysmal atrial fibrillation

目的观察预激综合征合并阵发性心房颤动(atrial fibrillation, AF)患者旁路射频消融术后再发AF情况,探讨AF再发的危险因素。方法 67例预激综合征合并阵发性AF患者,均行旁路射频消融术治疗。随访3-36(31.6±10.0)个月,11例再发AF者为再发AF组,56例未再发AF者为未再发AF组,比较2组年龄、性别、CHA_(2)DS_(2)-VASc评分及房间传导阻滞(interatrial block, IAB)比率等临床资料。将67例患者根据术后是否存在IAB分为IAB组及无IAB组,根据年龄分为>50岁组及≤50岁组,采用Kaplan-Meier法分析有无IAB及不同年龄组旁路射频消融术后AF再发率。多因素Cox回归分析预激综合征合并阵发性AF患者旁路射频消融术后AF再发的危险因素。结果再发AF组年龄>50岁(90.9%)、IAB(81.8%)、合并冠心病(27.3%)比率及CHA_(2)DS_(2)-VASc评分[2.0(1.0,3.0)分]均高于未再发AF组[39.3%、7.1%、1.8%、0.0(0.0±1.0)分](P<0.05),男性及合并糖尿病、高血压比率,左心房直径,左室射血分数,旁路前传有效不应期,旁路存在逆向传导、单旁路及多旁路预激综合征比率与未再发AF组比较差异均无统计学意义(P>0.05)。IAB组旁路消融术后AF再发率(69.2%)高于无IAB组(3.7%)(P<0.05),年龄>50岁组旁路消融术后AF再发率(31.3%)高于年龄≤50岁组(2.9%)(P<0.05)。多因素Cox回归分析结果显示,IAB(HR=29.03,95%CI:5.26-160.23,P<0.001)、年龄>50岁(HR=16.68,95%CI:1.61-172.82,P=0.018)是预激综合征合并阵发性AF患者旁路射频消融术后AF再发的危险因素。结论 IAB及年龄>50岁是预激综合征合并阵发性AF患者行旁路射频消融术后AF再发的危险因素。

Objective To observe recurrence of atrial fibrillation(AF)after accessory pathway ablation for Wolff-Parkinson-White(WPW)syndrome and paroxysmal AF,and to explore the risk factors of AF recurrence.Methods Sixty-seven patients with WPW syndrome and paroxysmal AF underwent accessory pathway ablation.During the follow-up of 3 to 36(31.6±10.0)months,11 patients developed recurrent AF(recurrent AF group)and 56 patients developed no recurrent AF(non-recurrent AF group).The age,gender,CHA_(2)DS_(2)-VASc score,and the percentage of interatrial block(IAB)were compared between two groups.All patients were divided into>50 years old group and≤50 years old group based on the age,and into IAB group and no-IAB group according to the occurrence of IAB after accessory pathway ablation.Kaplan-Meier method was used to analyze the recurrence rate of AF after accessory pathway ablation between groups.Multivariate Cox regression was used to analyze the risk factors of recurrent AF after accessory pathway ablation.Results The percentages of patients aged>50 years old and with IAB and with coronary artery disease as well as CHA_(2)DS_(2)-VASc score were higher in recurrent AF group(90.9%,81.8%,27.3%,2.0(1.0,3.0))than those in non-AF group(39.3%,7.1%,1.8%,0.0(0.0,1.0))(P<0.05),and there were no significant differences in percentages of male patients,diabetes and hypertension,left atrial diameter,left ventricular ejection fraction,effective refractory period of accessory pathway,antidromic conduction of accessory pathway,and single and multiple accessory pathway WPW syndrome between two groups(P>0.05).The recurrence rate of AF after accessory pathway ablation was higher in IAB group(69.2%)than that in no-IAB(3.7%)(P<0.05),and was higher in>50 years old group(31.3%)than that in≤50 years old group(2.9%)(P<0.05).Multivariate Cox regression analysis showed that IAB(HR=29.03,95%CI:5.26-160.23,P<0.001)and age of>50 years(HR=16.68,95%CI:1.61-172.82,P=0.018)were the risk factors of AF recurrence after accessory pathway ablation in patients with WPW syndrome and paroxysmal AF.Conclusion IAB and age of>50 years are the risk factors of AF recurrence after accessory pathway ablation in patients with WPW syndrome and paroxysmal AF.