心率减速力与心房颤动射频消融术后复发的相关性

Correlation between deceleration capacity of heart rate and recurrence after catheter radiofrequency ablation of atrial fibrillation

目的探讨心率减速力(DC)与心房颤动射频消融术中发生迷走神经反射、术后心率变异性变化及预后复发的相关性。方法选择行射频消融术治疗的心房颤动患者200例,按术后3个月预后复发状况分为复发组(88例)和未复发组(112例),对比2组一般资料,采用Logistic回归分析影响心房颤动射频消融术后预后复发的危险因素,并分析心率减速力与心房颤动射频消融术中发生迷走神经反射、术后心率变异性的关系。结果单因素分析显示,2组年龄、病程、性别、饮酒、吸烟、糖尿病、高血压、冠心病、迷走神经反射、?左室射血分数(LVEF)、左房内径、术前心率(HR)、术后HR、术前RR间期平均值标准差(SDANN)、术后SDANN、术前RR间期标准差(SDNN)、术后SDNN、术前三角指数、术后三角指数、术前相邻RR间期差均方根(r-MSSD)、术前低频功率(LF)、术后LF、术前高频功率(HF)、术前总功率(TP)、术后TP、术前LF/HF、术前DC比较,差异无统计学意义(P>0.05);术后r-MSSD、术后HF、术后LF/HF、术后心率DC比较,差异具有统计学意义(P<0.05)。Logistic回归模型显示,术后r-MSSD、术后HF、术后LF/HF、术后DC均是心房颤动射频消融术后预后复发的危险因素(P<0.05)。与未发生迷走神经反射比较,发生迷走神经反射术前DC、术后DC均更低(P<0.05)。Pearson相关性显示,术后DC与术后SDNN、术后SDANN、术后r-MSSD、术后三角指数、术后TP、术后LF、术后HF均呈正相关,与术后LF/HF呈负相关(P<0.05)。结论术后r-MSSD、术后HF、术后LF/HF、术后DC均是心房颤动射频消融术后预后复发的危险因素,且心率减速力与心房颤动射频消融术中发生迷走神经反射、术后心率变异性密切相关。

Objective To explore the correlation between deceleration capacity(DC)of heart rate and vagus reflex,postoperative changes in heart rate variability,and prognosis recurrence during catheter radiofrequency ablation of atrial fibrillation.Methods 200 patients with atrial fibrillation who underwent catheter radiofrequency ablation were selected and divided into the recurrence group(n=88)and the non recurrence group(n=112)according to prognosis recurrence status at 3 months after surgery.General data of two groups were compared.Logistic regression analysis was used to identify the risk factors affecting the prognosis recurrence of atrial fibrillation after catheter radiofrequency ablation.The correlation between DC of heart rate and the occurrence of vagus reflex and postoperative changes in heart rate variability during catheter radiofrequency ablation was analyzed.Results Univariate analysis showed that there were no statistically significant differences in age,course of disease,sex,alcohol consumption,smoking,diabetes,hypertension,coronary heart disease,vagus reflex,left ventricular ejection fraction(LVEF),left atrial diameter,preoperative heart rate(HR),postoperative HR,preoperative standard diviation of average NN intervals(SDANN),postoperative SDANN,preoperative standard diviation of NN intervals(SDNN),postoperative SDNN,preoperative triangular index,postoperative triangular index,preoperative root mean square of difference between adjacent NN intervals(r-MSSD),preoperative low frequency(LF),postoperative LF,preoperative high frequency(HF),preoperative total power(TP),postoperative TP,preoperative LF/HF,and preoperative DC of heart rate between two groups(P>0.05).There were statistically significant differences in postoperative r-MSSD,postoperative HF,postoperative LF/HF,and postoperative DC between two groups(P<0.05).The Logistic regression model showed that postoperative r-MSSD,postoperative HF,postoperative LF/HF,and postoperative DC were all risk factors for postoperative recurrence of atrial fibrillation after catheter radiofrequency ablation(P<0.05).Compared with the absence of vagus reflex,the preoperative DC and postoperative DC with vagus reflex were lower(P<0.05).Pearson correlation analysis showed that postoperative DC was positively correlated with postoperative SDNN,postoperative SDANN,postoperative r-MSSD,postoperative triangular index,postoperative TP,postoperative LF,and postoperative HF,while postoperative DC was negatively correlated with postoperative LF/HF(P<0.05).Conclusion Postoperative r-MSSD,postoperative HF,postoperative LF/HF,and postoperative DC are all risk factors for postoperative recurrence of atrial fibrillation after catheter radiofrequency ablation,and DC of heart rate is closely related to the occurrence of vagus reflex and postoperative heart rate variability during catheter radiofrequency ablation of atrial fibrillation.