环肺静脉隔离联合左心房自主神经节消融对阵发性房颤患者长期预后的影响

Effect of pulmonary vein isolation combined with left atrial ganglionated plexi ablation on the prognosis of patients with paroxysmal atrial fibrillation

目的评价环肺静脉隔离(pulmonary vein isolation,PVI)联合左心房自主神经节(ganglionated plexi,GP)消融对阵发性心房颤动(简称房颤)患者长期预后的影响。方法回顾性分析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首次行射频消融术的108例阵发性房颤患者的临床资料,按治疗方式的不同分为PVI组和PVI+GP组,每组54例,以术后复发房性心律失常为随访终点,比较两组术后复发情况。结果所有患者术后随访6~50个月,中位时间28.5个月,PVI组有36例(66.7%)复发房性心律失常,PVI+GP组有23例(42.6%)复发房性心律失常。Kaplan-Meier曲线分析显示,PVI+GP组的无房性心律失常复发生存率(57.4%)高于PVI组(33.3%),差异有显著性(P=0.044)。Cox回归分析显示,是否联合GP消融是阵发性房颤消融术后复发的独立危险因素(HR=0.459,95%CI 0.220~0.958,P=0.038)。结论与单纯的PVI相比,PVI+GP消融治疗降低了阵发性房颤患者消融术后的房性心律失常复发率。

Objective To evaluate the effect of circular pulmonary vein isolation combined with expanded left atrial ganglionated plexi(GP)ablation on the prognosis of patients with paroxysmal atrial fibrillation.Method A retrospective analysis of 108 patients with paroxysmal atrial fibrillation who underwent radiofrequency ablation in Department of Cardiology,Beijing Friendship Hospital,Capital Medical University from March 2013 to September 2016,were followed up for the recurrence of atrial arrhythmia.Patients were divided into two groups,PVI and PVI+GP,according to the operation method.Fifity-eight patients were enrolled in each group.Result There were 36 patients(66.7%)in the PVI group with recurrent atrial arrhythmia,and 23 patients(42.6%)in the PVI+GP group with recurrent atrial arrhythmia.Kaplan-Meier curve analysis showed that the survival rate without atrial arrhythmia recurrence in the PVI+GP group was higher than that in the PVI group(57.4%vs 33.3%,P=0.044).COX regression analysis showed that whether combined with GP ablation was an independent risk factor for post-ablation recurrence in patients with paroxysmal atrial fibrillation(HR=0.459,95%CI 0.220-0.958,P=0.038).Conclusion Compared with circular pulmonary vein isolation,combined with left atrial ganglionated plexi ablation can reduce the recurrence rate of atrial fibrillation after ablation in patients with paroxysmal atrial fibrillation.