王传慧,郁怡,王群山,孙健,冯向飞,刘博,张澎湃,王君,张睿,汪智全,李毅刚

• 1:上海交通大学医学院附属新华医院心内科
• 2:上海交通大学医学院附属新华医院超声科

摘要(Abstract)：

目的分析导管消融术联合心腔内电复律治疗非阵发性心房颤动(房颤)远期复发的影响因素。方法选取2009年1月至2014年12月上海交通大学医学院附属新华医院行多步骤递进式消融后,房颤仍未终止,术中再经静脉导管心腔内电复律法进行电复律的非阵发性房颤患者62例。随访12~48个月,对可能影响远期复发的因素进行分析。结果经导管消融术后持续房颤发作的所有非阵发性房颤患者,经静脉导管心腔内电复律治疗后均转复为窦性心律。根据是否远期复发,将患者分为复发组(26例)和未复发组(36例)。复发组患者的房颤病程显著长于未复发组[60(0.25,360)个月比24(0.25,120)个月,P=0.019],左心室重量指数[(150.16±34.48)g/m~2比(132.97±27.33)g/m~2,P=0.033]、左心房容积[(75.33±32.03)ml比(59.51±22.36)ml,P=0.025]、左心房容积指数[(40.70±15.81)ml/m~2比(32.21±12.76)ml/m~2,P=0.023]均显著高于未复发组,差异均有统计学意义。多因素回归分析显示,房颤病程是术后远期复发的独立危险因素(OR1.017,95%CI 1.003~1.032,P=0.017)。结论导管消融术联合经静脉导管心腔内电复律可将非阵发性房颤成功转复为窦性心律,房颤病程是患者远期复发的独立危险因素。

关键词(KeyWords)： 非阵发性心房颤动;导管消融术;经静脉导管心腔内电复律;远期复发

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目(81270259)

作者(Author): 王传慧,郁怡,王群山,孙健,冯向飞,刘博,张澎湃,王君,张睿,汪智全,李毅刚

参考文献(References)：

• [1]张玉生,徐安定,王拥军,等.缺血性卒中/短暂性脑缺血发作患者合并心房颤动的筛查及抗栓治疗中国专家共识.中华内科杂志,2014,53(8):665-671.
• [2]黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议—2015.中华心律失常学杂志,2015,19(5):321-384.
• [3]孟恬宇,高娟,武金娥,等.心房颤动患者经导管射频消融术后的疗效观察.西安交通大学学报(医学版),2015,36(6):796-800.
• [4]Anthony GB,Martin KS,Julien Laborderie,et al.Outcomes of long-standing persistent atrial fibrillation ablation:a systematic review.Heart Rhythm,2010,7(6):835-846.
• [5]尚应方,梁兆光.房颤射频消融术的结果评估.国际心血管病杂志,2014,41(6):395-397.
• [6]冯向飞,李毅刚,王群山,等.逐级消融在非阵发性心房颤动中的临床应用.中华心血管病杂志,2010,38(1):39-42.
• [7]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:Executive Summary.J Am Coll Cardiol,2014,64(21):2246-2280.
• [8]Lang RM,Badano LP,Mor-Avi V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr,2015,28(1):1-39.e14.
• [9]Huang B,Yang YM.Radiofrequency catheter ablation of atrial fibrillation in patients with chronic obstructive pulmonary disease:opportunity and challenge:response to Dr.Kumar's comment.J Am Med Dir Assoc,2015,16(1):83-84.
• [10]Raatikainen MJP,Hakalahti A,Uusimaa P,et al.Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation:On-treatment analysis of the randomized controlled MANTRA-PAF trial.Int J Cardiol,2015,198:108-114.
• [11]Yin ZT,Wang HS,Wang ZW,et al.The midterm results of radiofrequency ablation and vagal denervation in the surgical treatment of long-standing atrial fibrillation associated with rheumatic heart disease.Thorac Cardiovasc Surg,2015,63(3):250-256.
• [12]Nattel S,Burstein B,Dobrev D.Atrial remodeling and atrial fibrillation:mechanisms and implications.Circ Arrhythm Electrophysiol,2008,1(1):62-73.
• [13]蒋晨曦,马长生,董建增,等.阵发性心房颤动肺静脉隔离后诱发房性心律失常的电生理特征分析和长期随访.中国介入心脏病学杂志,2014,22(4):205-209.
• [14]Bailey GW,Braniff BA,Hancock EW,et al.Relation of left atrial pathology to atrial fibrillation in mitral valvular disease.Ann Intern Med,1968,69(1):13-20.