老年心房颤动患者导管射频消融术后复发现状及其影响因素

Status quo and influencing factors of atrial fibrillation recurrence in elderly patients after radiofrequency catheter ablation

目的研究老年心房颤动(AF)患者导管射频消融术(RFCA)后复发现状及其影响因素。方法选取2019年1月至2019年12月上海交通大学医学院附属新华医院接受RFCA治疗的794例AF患者为样本开展研究,术后采用24 h动态心电图随访1年,根据是否复发将患者分为复发组和对照组,分析术后复发危险因素,建立logistic回归模型并评估其预测价值。采用SPSS 23.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。采用多因素logistic回归分析研究老年AF患者RFCA术后复发的影响因素。结果794例患者失访8例(1.01%),完成随访的786例患者中复发104例(15.25%)。多因素logistic回归分析显示,年龄(OR=1.113,95%CI 1.041~1.190)、糖尿病(OR=1.697,95%CI 1.018~2.831)、左房内径(LAD;OR=1.135,95%CI 1.025~1.257)、低密度脂蛋白胆固醇(LDL-C;OR=1.229,95%CI 1.044~1.446)以及超敏C反应蛋白(hs-CRP;OR=1.096,95%CI 1.004~1.197)为老年AF患者RFCA术后复发独立危险因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示:根据logistic回归模型预测AF患者RFCA术后复发风险的ROC曲线下面积为0.939(95%CI 0.885~0.973;P<0.001),Hosmer-Lemeshow检验显示预测值与实际观测值具有良好一致性(χ^(2)=1.279;P=0.461)。结论老年AF患者RFCA术后复发率较高,其中年龄、糖尿病、LAD、LDL-C和hs-CRP是术后复发的独立危险因素,根据上述因素建立的logistic回归模型对预测复发具有良好参考价值。

Objective To investigate the status quo and influencing factors of atrial fibrillation(AF)recurrence in the elderly patients after radiofrequency catheter ablation(RFCA).Methods A sample of 794 AF patients who received RFCA treatment in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to December 2019 were selected in this study.The patients were followed up with 24-hour dynamic electrocardiogram for 1 year,and they were divided into recurrence group and control group according to whether there was recurrence.The risk factors of postoperative recurrence were analyzed.A logistic regression model was established,and its predictive value was evaluated.SPSS statistics 23.0 was used for statistical analysis.Data comparison between two groups was performed using t test orχ^(2) test depending on data type.Multivariate logistic regression analysis was performed to investigate the influencing factors of AF recurrence in elderly patients after RFCA.Results During 1-year follow-up,8(1.01%)of the 794 patients were lost to follow-up,and 104(15.25%)of the 786 patients who completed the follow-up had recurrence.Multivariate logistic regression analysis showed that age(OR=1.113,95%CI 1.041-1.190),diabetes mellitus(OR=1.697,95%CI 1.018-2.831),left atrial diameter(LAD;OR=1.135,95%CI 1.025-1.257),low-density lipoprotein cholesterol(LDL-C;OR=1.229,95%CI 1.044-1.446)and high-sensitivity C reactive protein(hs-CRP;OR=1.096,95%CI 1.004-1.197)were independent risk factors of AF recurrence in elderly patients after RFCA(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve in the logistic regression model for predicting the AF recurrence risk in the patients after RFCA was 0.939(95%CI 0.885-0.973;P<0.00),and Hosmer-Lemeshow test indicated a good consistency between the predictive value and the observed value(χ^(2)=1.279;P=0.461).Conclusion The AF recurrence rate after RFCA is high in elderly patients,and age,diabetes mellitus,LAD,LDL-C and hs-CRP are independent risk factors of postoperative recurrence.A logistic regression model based on the above factors has a good reference value in predicting recurrence.