肥厚型心肌病患者心房颤动导管消融术后早期复发对远期预后的影响

Effect of early recurrence of atrial tachyarrhythmia on long-term outcom after catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy

目的:探讨肥厚型心肌病患者心房颤动导管消融术后早期复发对远期预后的影响。方法:纳入2006年11月至2016年7月,于北京安贞医院行首次房颤导管消融术的肥厚型心肌病患者共91例(阵发性心房颤动/持续性心房颤动:60/31例)。消融策略:阵发性心房颤动患者行双侧肺静脉隔离;持续性心房颤动患者行双侧肺静脉隔离加左心房顶、二尖瓣峡部和三尖瓣峡部线性消融。术后定期随访患者的心电图或动态心电图,早期复发定义为导管消融术后3个月内心电图或动态心电图记录的持续时间≥30s的任何类型的房性快速心律失常(房性心动过速/心房扑动/心房颤动)。晚期复发定义为3个月后心电图或动态心电图记录的任何类型的≥30s的房性快速心律失常(房性心动过速/心房扑动/心房颤动)。根据是否发生早期复发将研究对象分为早期复发组和无早期复发组,观察并记录两组有无晚期复发以及晚期复发的时间以比较两组有无差异。结果:91例心房颤动患者术后共有59例发生晚期复发,其中74.6%(44/59)发生在1年内。共有23(25.3%)例患者发生早期复发,早期复发组其中1例在术后第1个月内发生早期复发,22例在术后第3个月内发生早期复发。发生早期复发的23例患者心动过速呈持续发作,随访过程中未曾转复窦性心律。与无早期复发组相比,早期复发组的晚期复发率显著增高[100%(23/23)vs.52.9%(36/68), Log-Rank P <0.001]。多因素COX回归分析表明,早期复发是晚期复发的独立危险因素(HR=71.43,95%CI:9.71~512.13,P <0.001)。结论:合并肥厚型心肌病的心房颤动患者射频消融术后早期复发与晚期复发有显著相关性,合并肥厚型心肌病心房颤动导管消融术后早期复发鲜有延迟治愈。

Objective: This study aimed to investigate the relationship between early recurrence and long-term outcome after catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy.Methods:A total of 91 patients with hypertrophic cardiomyopathy underwent the first catheter ablation of atrial fibrillation in Beijing Anzhen Hospital from November 2006 to July 2016(paroxysmal atrial fibrillation/persistent atrial fibrillation: 60/31 cases).Ablation strategy included bilateral pulmonary veins isolation for paroxysmal atrial fibrillation(n =60) and pulmonary veins isolation plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent atrial fibrillation(n=31).Early recurrence of atrial tachyarrhythmia was defined as any recurrence of atrial tachyarrhythmia > 30 seconds during the firs 3 months after ablation.Late recurrence of atrial tachyarrhythmia was defined as any recurrence after 3 months. According to the occurrence of early recurrence, the subjects were divided into early recurrence group and no early recurrence group, and the difference of late recurrence between the two groups was observed. Results:Of the 91 patients with atrial fibrillation, 23(25.3%) had early recurrence and 59 patients had late recurrence, of which 74.6%(44/59) occurred within 1 year. In the early recurrence group, 1 case had early recurrence within 1 month and 22 cases had early recurrence within 3 months after operation. 23 patients with early recurrence had persistent tachycardia and did not return to sinus rhythm during follow-up.These 23 patients with early recurrence all occurred late recurrence.Late arrhythmia recurrence rate in the early recurrence group(100%, 23/23) was higher than that in the no early recurrence group(52.9%, 36/68, P<0.001) after single procedure.Multivariate COX regression analysis,the early recurrence was the independent risk factor of late recurrence(HR=71.43,95% CI:9.71-512.13,P < 0.001).Conclusions:Early recurrence during 3 months in patients with hypertrophic cardiomyopathy undergoing catheter ablation of atrial fibrillation was significantly related to late recurrence. The patients with hypertrophic cardiomyopathy suffering early recurrence after catheter ablation rarely had delay cure in the follow-up.