青年心房颤动患者经二代冷冻球囊消融疗效及早期复发因素分析

Efficacy and recurrence factors of the second-generation cryoballoon ablation in young adults with atrial fibrillation

目的分析青年非瓣膜性心房颤动(房颤)患者导管消融疗效及复发因素。方法本研究为横断面研究。回顾性连续入选2019年1月至2020年12月入住北部战区总医院并接受二代冷冻球囊消融治疗的18~44岁诊断为房颤的青年患者(青年组),并在同期≥45岁房颤患者中按1∶2倾向评分匹配对照组,搜集患者临床资料,术后每3个月及第12个月对患者进行电话或门诊随访。结果共入选青年组患者48例,年龄(39.92±5.78)岁,对照组96例,年龄(59.27±7.54)岁,两组患者年龄、CHA_(2)DS_(2)-VAS_(C)评分差异具有统计学意义(P<0.001、P=0.023)。经1年随访共40例(27.78%,40/144)患者早期复发,其中青年组14例(29.17%,14/48),对照组26例(27.08%,26/96),Kaplan-Meier生存曲线分析显示两组间术后1年生存率差异无统计学意义(Log-Rank:P=0.865)。青年组患者空白期发作、空腹血糖升高是其二代冷冻球囊消融术后早期复发的危险因素,空腹血糖每增加1 mmol/L,房颤患者术后早期复发概率增加78.9%(HR=1.789,95%CI 1.081~2.962,P=0.024)。总人群及对照组患者,空白期发作、持续性房颤是其二代冷冻球囊消融术后早期复发的危险因素。结论青年房颤患者尽早开展导管消融等干预措施进行节律控制,并严格控制血糖,可降低房颤术后复发风险。

Objective To analyze the efficacy and recurrence factors of the second-generation cryoballoon ablation in young patients with non-valvular atrial fibrillation(AF).Methods A cross-sectional retrospective analysis was performed on young patients aged 18-44 years who were admitted to General Hospital of Northern Theater Command from January 2019 to December 2020 and received second-generation cryoballoon ablation(young group).The patients with atrial fibrillation≥45 years old in the same period were matched with the control group according to the 1∶2 propensity score.The general information and laboratory test were analyzed retrospectively.The patients were followed up by telephone or outpatient every 3 months and 12 months after operation.Results A total of 48 patients in the young group with an age of(39.92±5.78)years,and 96 patients in the control group with an age of(59.27±7.54)years were enrolled in the study.There were significant differences in age and CHA_(2)DS_(2)-VAS_(c)score between the two groups(P<0.001,P=0.023).After one-year follow-up,a total of 40 patients(27.78%,40/144)had early recurrence,including 14 patients in the young group(29.17%,14/48)and 26 patients in the control group(27.08%,26/96).Kaplan-Meier survival analysis showed that there was no significant difference in 1-year survival rate between the two groups(Log-Rank:P=0.865).Blanking recurrence and elevated fasting blood glucose in young patients were the risk factors of early recurrence after second-generation cryoballoon ablation.For every 1 mmol/L increase in fasting blood glucose,the probability of early recurrence in patients with AF increased by 78.9%(HR=1.789,95%CI 1.081-2.962,P=0.024).In the total population and the control group,the blanking recurrence and persistent AF were the risk factors of early recurrence after second-generation cryoballoon ablation.Conclusion Early intervention measures such as catheter ablation should be taken to control the rhythm and strictly control blood sugar in young patients with AF,in order to reduce the risk of postoperative recurrence of AF.