完全性右束支传导阻滞对阵发性心房颤动导管消融术后复发的影响

Complete right bundle branch block and risk of recurrence of paroxysmal atrial fibrillation after catheter ablation

目的 探讨完全性右束支传导阻滞(complete right bundle branch block,CRBBB)对阵发性心房颤动(房颤)导管消融术后复发的影响。方法 连续回顾性选择2018年1月至2020年12月到阜外华中心血管病医院住院行房颤导管消融的阵发性房颤患者。所有入选患者均行静息12导心电图以评价CRBBB存在情况,CRBBB定义为心电图QRS波持续时间≥120 ms,Ⅰ、V6导联S波时限>R波时限,V1和(或)V2导联QRS波群呈RsR′,R′>R。房颤复发被定义为导管消融术后3月以上,未应用抗心律失常药物的条件下出现持续30 s以上的快速性房性心律失常。结果 共入选486例患者,其中5.8%(28/486)的患者存在CRBBB。平均随访22.5±9.8月(4~48),86例(17.7%)患者出现房颤复发。CRBBB患者的复发率高于无CRBBB患者(35.7%对16.6%,P=0.02)。Kaplan-Meier生存曲线分析显示CRBBB患者无房颤生存率显著低于无CRBBB患者(log-rank检验,P=0.003)。多因素Cox回归分析显示,CRBBB(HR=2.296;95%CI 1.172~4.499,P=0.015)、心力衰竭(HR=3.589,95%CI 1.537~8.377,P=0.003)是房颤复发的独立危险因素。结论 存在CRBBB的阵发性房颤患者导管消融术后有较高的房颤复发率。

Objective To explore the effect of complete right bundle branch block(CRBBB)on the recurrence of paroxysmal atrial fibrillation(AF)after catheter ablation.Methods A totle of 486 consecutive patients with paroxysmal AF who were hospitalized at the Heart Center of Henan Provincial People’s Hospital for radiofrequency ablation between January 2018 to December 2020 were retrospectively reviewed.All the ECG recordings were analyzed to detect CRBBB.CRBBB was defined as a late R(R′)wave in lead V1 or V2 with a slurred S wave in lead I and/or lead V6 with a prolonged QRS duration(≥120 ms).AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30 s beyond 3 months after catheter ablation.Results Among the 486 patients,CRBBB was detected in 28 patients(5.8%).During a mean follow up of 22.5±9.8 months(range,4~48 months),86 patients(17.7%)developed recurrence of AF.The recurrence rate of AF was higher in patients with CRBBB than in those without CRBBB(35.7%vs.16.6%,P=0.02).Multivariable Cox proportional hazards regression analysis showed that CRBBB(HR=2.296,95%CI 1.172-4.499,P=0.015)and heart failure(HR=3.589,95%CI 1.537-8.377,P=0.003)were the independent risk factors of recurrence.Conclusion Patients with CRBBB have an increased risk of AF recurrence after catheter ablation.