房颤合并心衰患者节律控制治疗预后的影响因素

Influencing factors of prognosis of patients with atrial fibrillation and heart failure after rhythm control therapy

目的:研究房颤合并心衰患者节律控制治疗预后的影响因素。方法:依据节律控制方式,于我院治疗的379例房颤合并心衰患者被分为药物治疗组(133例)和手术治疗组(246例,行房颤导管消融手术),依据房颤类型,患者被分为阵发性房颤组(208例)和持续性房颤组(171例),比较各组一般临床资料及节律控制疗效;依据NYHA心功能分级,患者被分为NYHAⅡ级组(160例)、Ⅲ级(188例)和Ⅳ级组(31例),比较各组的节律控制疗效。结果:与药物治疗比较,阵发性房颤组、持续性房颤组、NYHAⅡ级、Ⅲ级组手术治疗房颤复发比例、治疗后LAD均显著降低,心功能改善比例显著升高(P<0.05或<0.01)。多因素Logistic回归分析显示,药物治疗、持续性房颤为节律控制治疗后房颤复发、心功能未改善的独立危险因素(OR=2.426~7.908,P均=0.001),NYHAⅡ级为节律控制治疗后房颤复发的独立保护因素(OR=0.393,P=0.049)。结论:房颤导管消融术可显著改善房颤合并心衰患者的预后,持续性房颤、抗心律失常药物治疗是节律控制治疗预后不佳的独立危险因素。

Objective:To study influencing factors of prognosis of patients with atrial fibrillation(AF)and heart failure(HF)after rhythm control therapy.Methods:According to rhythm control methods,a total of 379 AF+HF patients treated in our hospital were divided into medication group(n=133)and surgery group(n=246,received catheter ablation of AF);according to AF type,patients were divided into paroxysmal AF group(n=208)and persistent AF group(n=171),and general clinical data and rhythm control effect were compared among all groups.According to NYHA cardiac function classification,patients were divided into NYHA classⅡgroup(n=160),classⅢgroup(n=188)and classⅣgroup(n=31),and rhythm control effect was compared among above groups.Results:Compared with medication,there were significant reductions in percentage of AF recurrence and LAD after treatment,and significant rise in percentage of heart function improvement in paroxysmal AF group,persistent AF group,NYHA classⅡandⅢgroup in those underwent surgery(P<0.05 or<0.01).Multivariate Logistic regression analysis indicated that medication,persistent AF were independent risk factors for AF recurrence and no cardiac function improvement after rhythm control therapy(OR=2.426~7.908,P=0.001 all),and NYHA classⅡwas an independent protective factor for AF recurrence after rhythm control therapy(OR=0.393,P=0.049).Conclusion:Atrial fibrillation catheter ablation can significantly improve prognosis of AF+HF patients.Persistent AF and antiarrhythmic medication are independent risk factors for poor prognosis after rhythm control therapy.