非肺静脉触发灶消融对阵发性房颤并房扑患者预后及危险因素分析

Analysis of prognosis and risk factors of Non-pulmonary Vein Triggers Ablation on patients coexist with paroxysmal atrial fibrillation and atrial flutter

目的研究阵发性房颤并房扑患者的临床特点及消融术式,探讨非肺静脉触发灶消融对其预后的影响,并分析相关危险因素。方法本研究为单中心、回顾性研究,选择阜外华中心血管病医院于2017年1月至2020年1月间完成射频导管消融的阵发性房颤并房扑患者179例,所有患者均接受环肺静脉隔离术,必要时行非肺静脉触发灶消融。根据是否行非肺静脉触发灶隔离的术式,将阵发性房颤并房扑患者分为两组,141例(78.77%)仅行环肺静脉隔离(CPVI组),38例(21.23%)环肺静脉隔离加非肺静脉触发灶消融(N-CPVI组)。随访3~12个月后采用Kaplan-Meier生存曲线和log-rank检验评估阵发性房颤并房扑患者射频消融术后的复发率。采用多因素COX回归模型分析阵发性房颤并房扑患者消融术后复发的危险因素。结果与CPVI组相比,N-CPVI组更多高血压(P=0.009)、糖尿病(P=0.030),N-CPVI组患者左房内径>40 mm比例(P=0.010)及LVEDD>50 mm比例更高(P=0.027)。Kaplan-Meier生存曲线结果显示,阵发性房颤并房扑患者导管消融术后CPVI组的窦律维持率高于N-CPVI组(P=0.004)。多因素COX回归分析发现,高血压(HR=3.38,95%CI:1.15~5.95,P=0.037)、非肺静脉触发灶消融(HR=1.37,95%CI:1.17~2.78,P=0.009)是阵发性房颤并房扑患者导管消融术后复发的独立危险因素。结论非肺静脉触发灶消融、合并高血压是阵发性房颤并房扑患者导管消融后复发的独立危险因素。

Objective To investigate the clinical characteristics and the risk factors for recurrence in patients coexist with paroxysmal atrial fibrillation and atrial flutter after non-pulmonary vein trigger isolation.Method This is a single-center,retrospective study.One hundred and seventy-nine patients with paroxysmal atrial fibrillation and atrial flutter who underwent catheter ablation from Jan 2017 to Jan.2020 were enrolled in this study.All the patients received circumferential pulmonary vein antrum isolation(CPVI),with non-pulmonary vein trigger isolation if needed.They were divided into two groups depending on whether ablating the non-pulmonary vein triggers:only CPVI in the CPVI group(141cases,78.77%),CPVI and non-pulmonary trigger ablation in the N-CPVI group(38 cases,21.23%).The recurrence was evaluated at follow-up for 3-12 months after radiofrequency ablation.Multivariate Cox regression analysis was used to explore the risk factors for recurrence.Kaplan-Meier survival curve was used to compare the recurrence between the CPVI group and the N-CPVI group by Log-rank test.Results Compared with the CPVI group,the N-CPVI group had more hypertension(P=0.009)and diabetes(P=0.030),and the proportion of left atrial diameter>40 mm(P=0.010)and LVEDd>50 mm in N-CPVI group were higher(P=0.027).Kaplan Meier survival curve showed that the maintenance rate of sinus rhythm in the CPVI group was higher than that in the N-CPVI group after catheter ablation for patients with paroxysmal atrial fibrillation and atrial flutter(P=0.004).Multivariate COX regression analysis showed that hypertension(HR=3.38,95%CI:1.15~5.95,P=0.037)and ablation of non-pulmonary vein trigger focus(HR=1.37,95%CI:1.17~2.78,P=0.009)were independent risk factors for recurrence of patients with paroxysmal atrial fibrillation and atrial flutter after catheter ablation.Conclusion Non-pulmonary triggers ablation and hypertension had been found two independent risk factors associated with the recurrence of patients coexist with paroxysmal atrial fibrillation and atrial flutter after catheter ablation.