典型心房扑动患者射频消融术后发生心房颤动的危险因素分析

Risk factors of atrial fibrillation in patients with typical atrial flutter after radiofrequency ablation

目的探讨典型心房扑动(房扑)患者射频消融术后发生心房颤动(房颤)的危险因素。方法该研究为病例对照研究。连续纳入2017年1月1日至2021年1月1日于邢台市人民医院就诊的因典型房扑行射频消融术的患者。根据射频消融术后是否发生房颤分为发生房颤组和未发生房颤组。通过电子病历系统、实验室及检查归档系统、手术记录收集相关的临床资料。射频消融术后,每3~6个月随访1次,随访2年,评估随访期间患者是否发生了房颤。采用单因素和多因素Cox回归模型分析典型房扑患者射频消融术后发生房颤的危险因素。结果共入选患者120例,年龄(62.0±6.5)岁,男性64例(53.3%),其中发生房颤组30例、未发生房颤组90例。发生房颤组患者的年龄、CHA_(2)DS_(2)-VASC评分、P波宽度、左心房内径均大于未发生房颤组患者(均P<0.05)。单因素Cox回归分析结果显示,年龄、P波宽度、左心房内径和CHA_(2)DS_(2)-VASC评分是典型房扑患者射频消融术后发生房颤的危险因素(均P<0.001)。多因素Cox回归分析结果显示,年龄(HR=1.09,95%CI:1.01~1.17,P=0.025)、CHA_(2)DS_(2)-VASC评分(HR=3.84,95%CI:1.87~7.89,P<0.001)是典型房扑患者射频消融术后发生房颤的独立危险因素。结论年龄和CHA_(2)DS_(2)-VASC评分是典型房扑患者射频消融术后发生房颤的独立危险因素。

Objective To investigate the risk factors of atrial fibrillation(AF)in patients with typical atrial flutter after radiofrequency ablation.Methods This study was a case-control study.The clinical data of 120 patients with typical atrial flutter who underwent radiofrequency ablation in Xingtai People′s Hospital from January 2017 to January 2021 were retrospectively analyzed.Patients were followed up every 3-6 months for a period of 2 years,and AF occurred in 30 patients(25.0%).The risk factors of AF were analyzed with univariate and multivariate logistic regressions.Results The mean age of patients was(62.0±6.5)years and 64(53.3%)were males.No patients in the two groups had complications such as cardiac tamponade,pulmonary embolism and cerebral infarction after radiofrequency ablation.Compared with non-AF patients,patients in AF group had older age and higher CHA_(2)DS_(2)-VASC score(P<0.001).Multivariate regression analysis showed that age(HR=1.09,95%CI:1.01-1.17)and CHA_(2)DS_(2)-VASC score(HR=3.84,95%CI:1.87-7.89)were independent risk factors for the occurrence of atrial fibrillation after radiofrequency ablation in patients with atrial flutter.Conclusion After radiofrequency ablation of typical atrial flutter,nearly 25%of patients will relapse into AF,old age and higher CHA_(2)DS_(2)-VASC score increase the risk of AF recurrent.