沈才杰,陈晓敏,何斌,郁一波,刘晶,丰明俊,黄启峰,储慧民

• 1:浙江省宁波市第七医院心内科

摘要(Abstract)：

目的探讨心房颤动(房颤)致心动过速性心肌病(TCM)患者及导管射频消融(RFCA)术后左心室射血分数(LVEF)恢复的影响因素。方法将296例房颤患者分为两组,TCM组32例(LVEF<50%,1组),非TCM组(LVEF≥50%)264例(2组),1组RFCA术后分为LVEF恢复组23例(LVEF≥50%,3组)与未恢复组9例(LVEF<50%,4组),经体表心电图及Holter记录心动过速的平均病程(MCD)、平均持续时间(MPT)及平均心室率(MHR)及术后MPT、MHR,经心脏彩色多普勒超声获取左心室舒张末期内径(LVEDD)及左心房内径(LAD)。随访(7±1.9)个月,研究房颤致TCM及RFCA术后LVEF恢复的影响因素。结果 (1)1组较2组持续性房颤(PeAF)患者多见(χ2=14.6,P<0.01),术前1组心动过速时MPT(t=3.182,P<0.05)及MCD高于2组(t=2.15,P<0.05),MHR显著低于2组(t=-5.384,P<0.05),LAD(t=4.864,P<0.05)及LVEDD(t=2.206,P<0.05)大于2组;(2)环肺静脉电隔离术后,1组较2组需更广范围的碎裂电位消融达到消融终止(χ2=12.04,P<0.01),两组消融终止率(62.5%比69.3%,χ2=0.62,P=0.43)及消融成功率(56.2%比70.1%,χ2=2.53,P=0.11)差异均无统计学意义;(3)与术前比较,1组术后LAD(t=2.09,P<0.05)及LVEDD显著缩小(t=2.44,P<0.05),且LVEF明显增加(t=-8.00,P<0.01)。与3组相比,4组术前MCD较高(t=2.95,P<0.05),术前术后LAD(t=2.64,P<0.05)(t=3.06,P<0.05)及LVEDD(t=2.57,P<0.05)(t=3.28,P<0.05)均较高(P<0.05)、LVEF(t=-3.70,P<0.01)(t=-5.00,P<0.01)较低,3组患者LVEF增幅较4组高(t=2.5,P=0.001);(4)多因素Logistic回归分析发现,PeAF(OR=4.37,P=0.01)、术前MHR(OR=0.936,P<0.0001)及MCD(OR=1.173,P=0.016)是预测房颤发生TCM的独立危险因素。4组术前MCD较3组长(t=2.95,P=0.007),但多元回归未发现术后LVEF恢复的预测因子。结论 PeAF、术前MHR及MCD为房颤致TCM的独立危险因素,RFCA可显著改善多数患者心脏结构和心功能,经较广泛基质消融后,消融成功率及远期预后与非TCM患者相近;未发现RFCA术后LVEF恢复的预测因子。

关键词(KeyWords)： 心房颤动;心肌疾病;导管消融术;每搏输出量;因素分析,统计学

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 沈才杰,陈晓敏,何斌,郁一波,刘晶,丰明俊,黄启峰,储慧民

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