一站式手术对房颤晚期复发率的影响及危险因素分析

Effect of one-stop procedure on late recurrence rate of atrial fibrillation and analysis of risk factors

目的探讨房颤一站式术后晚期房颤复发率及其危险因素。方法纳入2019年3月~2021年7月因房颤就诊于空军军医大学第二附属医院心血管内科的患者318例,根据手术方式分为一站式组(射频消融术联合左心耳封堵术,n=82)和单纯射频消融组(n=236),对比两组术后房颤晚期复发的情况。采用单因素及多因素Logistic回归分析一站式组内房颤晚期复发和未复发亚组间患者的年龄、性别、病程、房颤类型、LAD、LVEF和NLR等临床特征。结果一站式组和单纯射频消融组在年龄、性别、病程、BMI、CHA2DS2-VASc评分、HASBLED评分、房颤类型、合并症、左心房内径、左室射血分数的差异均无统计学意义。比较两组患者住院时长,一站式组明显长于单纯射频消融组(8.4±2.8 vs.6.7±2.1)天(P<0.01),差异有统计学意义。一站式组发生围术期并发症9例(11%),单纯射频消融组发生14例(6%),两组的差异无统计学意义,一站式组和单纯射频消融组术后均给予抗心律失常、抗凝药物治疗,两组药物使用率差别无统计学意义。一站式组术后房颤早期复发率高于单纯射频消融组(27%vs.13%,P<0.01),差异有统计学意义。两组术后晚期房颤复发率差异无统计学意义。多因素Logistic回归分析结果显示:房颤病程(OR:1.014,95%CI:1.000~1.027,P=0.05)、左心房内径(OR:1.182,95%CI:1.030~1.357,P<0.05)、术前中性粒细胞与淋巴细胞比率(OR:2.092,95%CI:1.146~3.819,P<0.05)和术后房颤早期复发(OR:13.884,95%CI:3.215~59.962,P<0.01)是一站式组术后房颤晚期复发的独立危险因素。结论一站式手术安全有效,不加重射频消融术后房颤晚期复发风险。房颤病程、左心房内径、术前中性粒细胞与淋巴细胞比率和术后房颤早期复发是一站式手术房颤晚期复发的独立危险因素。

AIM To study the late recurrence rate and risk factors of atrial fibrillation after one-stop procedure.METHODS Included in this study were 318 patients with atrial fibrillation who were hospitalized in the Department of Cardiology of Tangdu Hospital from March 2019 to July 2021,among whom 82 cases received one-stop procedure(radiofrequency ablation combined with left atrial appendage occlusion)and 236 cases received simple radiofrequency ablation operation.Between the two groups,late recurrence of atrial fibrillation was compared and univariate and multivariate logistic regression were used to analyze the clinical characteristics of the patients with or without late recurrent atrial fibrillation.RESULTS There was no significant difference in age,sex,course of disease,BMI,CHA2DS2-VASc score,HAS-BLED score,type of atrial fibrillation,complications,left atrial diameter and left ventricular ejection fraction between one-stop ablation group and simple radiofrequency ablation group.Comparing the length of hospitalization between the two groups,the one-stop group was significantly longer than the single radiofrequency ablation group(8.4±2.8 vs.6.7±2.1)days(P<0.01).Perioperative complications occurred in 9 cases(11%)in the one-stop group and 14 cases(6%)in the simple radiofrequency ablation group.There was no statistically significant difference between the two groups.Both the one-stop group and the simple radiofrequency ablation group were treated with antiarrhythmic and anticoagulant drugs after surgery.There was no statistically significant difference in drug use rates between the two groups.The early recurrence rate of postoperative AF in the one-stop group was higher than that in the radiofrequency ablation group(27%vs.13%,P<0.01).There was no significant difference in the recurrence rate of late postoperative atrial fibrillation between the two groups.The results of multivariate logistic regression analysis showed that the course of atrial fibrillation(or:1.014,95%CI:1.000-1.027,P=0.05),left atrial diameter(or:1.182,95%CI:1.030-1.357,P<0.05),preoperative neutrophil to lymphocyte ratio(or:2.092,95%CI:1.146-3.819,P<0.05)and early recurrence of postoperative atrial fibrillation(or:13.884,95%CI:3.215-59.962,P<0.01)were the late stage of postoperative atrial fibrillation in the one-stop group.Independent risk factors for recurrence.CONCLUSION One-stop procedure is safe and effective and does not increase the risk of late recurrence of atrial fibrillation after radiofrequency ablation.The duration of atrial fibrillation,left atrial diameter,preoperative neutrophil lymphocyte ratio and early postoperative recurrence of atrial fibrillation are independent risk factors of late recurrence of atrial fibrillation after one-stop procedure.