心率减速力变化率对房颤环肺静脉隔离术后复发的预测价值

Predictive value of deceleration capacity of heart rate in recurrence after circumferential pulmonary vein isolation in atrial fibrillation

目的:探讨阵发性心房颤动(房颤)患者行环肺静脉隔离(CPVI)术后心率减速力(DC)的变化及其对CPVI术后房颤复发的预测价值。方法:选取2015-01-2017-01在苏州大学附属第一医院心内科住院首次行CPVI术的阵发性房颤患者133例,分别于术前、术后急性期、术后3个月行Holter检查;术后急性期Holter检查于术后24~72 h进行;根据3个月空白期后是否复发,分为复发组(36例)和未复发组(97例);术后急性期DC值变化率为术后急性期与术前DC差值占术前DC值的比率;分析比较两组各时段DC值及变化率的差别,采用Kaplan-Meier法分析术后急性期DC变化率对CPVI术后房颤复发的影响。结果:①未复发组[(6.72±2.04) ms∶(3.99±1.90) ms,P<0.05]和复发组[(7.05±2.71) ms∶(4.53±1.36) ms,P<0.05]患者术后急性期DC值均较术前明显下降,两组间术前和术后急性期DC值均无明显差别,但复发组术后急性期DC变化率明显低于未复发组[(0.30±0.16)∶(0.44±0.26),P<0.05];②Kaplan-Merier法分析结果显示,术后急性期DC变化率<0.3的CPVI术后复发率明显增加(log rank=6.956,P<0.05)。结论:阵发性房颤患者CPVI术后急性期DC减低,提示迷走神经功能受损;CPVI术后急性期DC变化率<0.3对房颤复发有一定预警价值。

Objective:To investigate the changes of deceleration capacity of heart rate(DC)after circumferential pulmonary vein isolation(CPVI)in patients with paroxysmal atrial fibrillation(PAF)and its predictive value of recurrence.Method:From January 2015 to January 2017 in Department of Cardiology,the First Affiliated Hospital of Soochow University,133 patients were diagnosed with paroxysmal atrial fibrillation and suffered CPVI for the first time.Patients were required to return to the hospital before surgery,acute after surgery,and 3 months after surgery for Holter examination.Postoperative acute Holter examination was performed 24-72 hours after surgery.According to whether there was recurrence after the 3-month blank period,they were divided into recurrent group(n=36 cases)and non-recurred group(n=97 cases).The change rate of DC value in the acute phase after surgery was the ratio of the postoperative acute phase to the preoperative DC difference in preoperative DC values.The differences of DC values and rate of change between the two groups were analyzed and compared.And we use the Kaplan-Meier method to analyze the effect of postoperative acute DC rate on the recurrence of AF after CPVI.Result:①In the non-recurrent group(6.72±2.04 vs.3.99±1.90,P<0.05)and the recurrent group(7.05±2.71 vs.4.53±1.36,P<0.05),the postoperative acute DC values were significantly lower than those before surgery.And there was no significant difference in DC values between preoperative and postoperative acute phases.However,the rate of DC change in the acute phase was significantly lower than that in the non-recurrent group(0.30±0.16 vs.0.44±0.26,P<0.05).②Kaplan-Merier analysis showed that the recurrence rate of DC change in the acute phase<0.3 was significantly increased(log rank=6.956,P<0.05).Conclusion:The heart rate deceleration in patients with paroxysmal atrial fibrillation decreased after acute CPVI,suggesting impaired vagus nerve function.The rate of DC change in acute phase after CPVI<0.3 has a certain early warning value for the recurrence of atrial fibrillation.