宁夏心房颤动射频消融术后持续性房扑合并心力衰竭发生的影响因素

Analysis of Influencing Factors on the Occurrence of Persistent Atrial Flutter Combined with Heart Failure after Radiofrequency Ablation of Atrial Fibrillation in Ningxia

目的通过对心房颤动射频消融术后持续性房扑合并心力衰竭发生的影响因素的分析,为早期临床干预提供理论依据。方法选取2020年1月至2023年4月在宁夏回族自治区人民医院心血管中心心内科住院治疗心房颤动射频消融术后再发心房扑动的患者共50例作为研究对象,按术前是否合并心力衰竭分为发生持续性房扑合并心力衰竭组23例(心衰组)和发生持续性房扑未合并心力衰竭组27例(非心衰组)。术前1周给予胺碘酮片0.2 g,8 h/次口服,维持1周后行射频消融术,观察并记录两组患者的一般情况及行射频消融术前及术后1、3、6个月的左室舒张末期内径、右房上下径、右房横径、右室前后径、左室射血分数(LVEF)及N端脑钠肽前体(NT-proBNP)水平,进行Logistic回归分析。结果心衰组与非心衰组患者的性别、年龄、基础疾病及服用药物情况差异均无统计学意义(P均>0.05);两组患者的右房上下径、左室舒张末期内径、右房横径、LVEF、NT-proBNP差异均有统计学意义(P均<0.05)。Logistic回归分析显示,右房上下径>40 mm、左室舒张末期内径>50 mm、右房横径>45 mm、NT-proBNP>5000 pg·mL^(-1)为射频消融术后发生持续性房扑合并心力衰竭的危险因素。与术前相比,50例患者术后1、3、6个月右房上下径、左室舒张末期内径、NT-proBNP均降低,EF水平升高(P均<0.05);术后6个月右房横径降低(P<0.05)。结论右房上下径>40 mm、左室舒张末期内径>50 mm、右房横径>45 mm、NT-proBNP>5000 pg·mL^(-1)为射频消融术后发生持续性房扑合并心力衰竭的危险因素,可为术后提早进行有效干预提供参考。

Objective To provide a theoretical basis for early clinical intervention by analyzing the influencing factors of persistent atrial flutter combined with heart failure after radiofrequency ablation of atrial fibrillation.Methods A total of 50 patients undergoing radiofrequency ablation for atrial flutter in the Cardiology Department of the Cardiovascular Center of the People’s Hospital of Ningxia Hui Autonomous Region from January 2020 to April 2023 were selected as the study objects.They were divided into two groups according to whether they were complicated with heart failure before surgery,and 23 patients were in the group of persistent atrial flutter combined with heart failure(heart failure group).Continuous atrial flutter occurred in 27 patients without heart failure group(non-heart failure group).Amiodarone tablets were given 0.2 g one week before surgery one week,orally for 8 h/time,and radiofrequency ablation was performed one week later.The general conditions and imaging indicators before and 1,3 and 6 months after radiofrequency ablation were observed and recorded in the two groups.Logistic regression analysis was performed on left ventricular end-diastolic diameter,right atrial upper and lower diameter,right atrial transverse diameter,right anteroposterior diameter,left ventricular ejection fraction(LVEF)and NT-terminal brain natriuretic peptide precursor(NT-proBNP).Results There were no significant differences in gender,age,underlying diseases and drug use between the heart failure group and the non-heart failure group(P all>0.05).There were significant differences in right atrial upper and lower diameter,left ventricular end-diastolic diameter,right atrial transverse diameter,EF and NT-proBNP between the two groups(P all<0.05).Logistic regression analysis showed that right atrial upper and lower diameter>40 mm,left ventricular end-diastolic diameter>50 mm,right atrial transverse diameter>45 mm,NT-proBNP>5000 pg·mL^(-1)were risk factors for persistent atrial fibrillation complicated with heart failure after RF ablation.Compared with pre-operation,the right atrial upper and lower diameter,left ventricular end-diastolic diameter and NT-proBNP were significantly decreased in 50 patients 1,3 and 6 months after operation,and the EF level was significantly increased(P all<0.05).The transverse diameter of right atrium decreased significantly 6 months after operation(P<0.05).Conclusion Right atrial upper and lower diameter>40 mm,left ventricular end-diastolic diameter>50 mm,right atrial transverse diameter>45 mm,NT-proBNP>5000 pg·mL^(-1)were risk factors for persistent atrial fibrillation complicated with heart failure after radiofofency ablation,can provide reference for early and effective intervention after surgery.