老年阵发性心房颤动射频消融术后复发的危险因素分析

Analysis of related risk factors for recurrence after radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients

目的分析老年阵发性心房颤动(简称房颤)患者行射频消融术后复发的危险因素。方法选取2013年3月至2016年9月于首都医科大学附属北京友谊医院心内科住院首次行射频消融术的50例老年(年龄≥60岁)阵发性房颤患者。术后随访3个月~8年(中位随访时间5年),根据有无复发分为复发组与未复发组,分析老年阵发性房颤射频消融术后复发的危险因素。结果最终纳入42例患者,其中19例复发,复发率为45.2%。复发组19例,未复发组23例,两组房颤病程、左心房前后径差异有显著性(P<0.05)。多因素logistic回归分析显示左心房前后径扩大(P=0.045)、房颤病程长(P=0.013)是老年房颤患者射频消融术后远期复发的独立危险因素。结论左心房前后径扩大、房颤病程长是老年房颤患者射频消融术后远期复发的独立危险因素。老年阵发性房颤患者尽早手术可能有助于逆转心房重构,减少复发。

Objective To analyze the risk factors of recurrence after radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients.Method A total of 50 elderly patients(age≥60 years)with paroxysmal atrial fibrillation who were hospitalized at Department of Cardiology,Beijing Friendship Hospital,Capital Medical University from March 2013 to September 2016 who underwent radiofrequency ablation for the first time were enrolled.Follow-up was performed after operation,and the risk factors for recurrence after radiofrequency ablation were analyzed by comparing the preoperative clinical data.Result Forty-two patients were finally included in the study.A total of 19 patients relapsed with atrial arrhythmia,and the recurrence rate was 45.2%.There were statistically significant differences in the duration of atrial fibrillation and the anteroposterior diameter of the left atrium(P<0.05).Multivariate logistic regression analysis showed that enlarged anteroposterior diameter of the left atrium(P=0.045)and the duration of atrial fibrillation(P=0.013)were independent risk factors for long-term recurrence of atrial fibrillation in elderly patients.Conclusion The enlarged anteroposterior diameter of the left atrium and the duration of atrial fibrillation are independent risk factors for long-term recurrence after radiofrequency ablation of atrial fibrillation in elderly patients.For elderly patients with paroxysmal atrial fibrillation,early surgery may play a role in reversing atrial remodeling and may reduce recurrence.