左肺静脉共干心房颤动患者经导管消融疗效及影响因素分析

Effect and influencing factors of catheter ablation in patients with left pulmonary vein common dry atrial fibrillation

目的探讨左肺静脉共干的心房颤动(房颤)患者经导管消融的疗效及影响因素。方法将北部战区总医院自2019年1月至2020年7月收治的47例左肺静脉共干并接受导管消融的房颤患者纳入B组。根据选择导管消融术式,将B组患者分为射频消融亚组(n=25)与冷冻球囊消融亚组(n=22)。另将同期筛选肺静脉解剖正常房颤患者47例纳入A组。采用多因素Logistic回归法分析左肺静脉共干及其他因素与术后复发的相关性。结果B组患者的消融时间、放射线应用时间、放射线剂量均低于A组,差异均有统计学意义(P<0.05)。射频消融亚组患者的左肺静脉共干长度、共干上下径及前后径均大于冷冻球囊消融亚组,放射线时间、放射线剂量均低于冷冻球囊消融亚组,差异均有统计学意义(P<0.05)。B组患者的复发率为6.38%(3/47),低于A组的21.28%(10/47),差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,左肺静脉共干的房颤患者经术式选择后可降低房颤复发率(比值比0.154,95%可信区间0.029~0.808,P<0.05)。结论左肺静脉共干房颤患者导管消融术后复发率较肺静脉正常房颤患者低,选择合适的消融策略可能有助于改善房颤患者的预后。

Objective To investigate the effect and influencing factors of catheter ablation in patients with atrial fibrillation(AF)with left pulmonary vein common dry.Methods A total of 47 AF patients admitted to General Hospital of Northern Theater Command from January 2019 to July 2020 who had left pulmonary vein common dry and underwent catheter ablation were enrolled in group B.Patients in group B were divided into radiofrequency ablation subgroup(n=25)and cryoballoon ablation subgroup(n=22)according to the choice of catheter ablation.Another 47 patients with AF with normal pulmonary vein anatomy were included in group A.Multivariate Logistic regression was used to analyze the correlation between left pulmonary vein co-drying and other factors and postoperative recurrence.Results The ablation time,radiation application time and radiation dose in group B were all lower than those in group A,with statistical significance(P<0.05).The length,upper and lower diameter and anterior and posterior diameter of the common trunk of left pulmonary vein in the radiofrequency ablation subgroup were larger than those in the cryoballoon ablation subgroup,and the radiation time and dose were lower than those in the cryoballoon ablation subgroup,with statistical significance(P<0.05).The recurrence rate in group B was 6.38%(3/47),lower than 21.28%(10/47)in group A,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that patients with AF with left pulmonary vein common dry could reduce the recurrence rate of AF after surgical selection(odds ratio 0.154,95%confidence interval 0.029-0.808,P<0.05).Conclusion The recurrence rate of patients with left pulmonary vein common dry af after catheter ablation is lower than that of patients with normal pulmonary vein AF.The selection of appropriate ablation strategy may improve the prognosis of patients with AF.