夏桂玲,杨龙,杨英,何炯红,郭楚娴,霍照美,田野,刘启方,蒋智,田龙海,黄晶

• 1:贵州省人民医院心内科

摘要(Abstract)：

目的 探讨戒酒对饮酒男性心房颤动（房颤）患者经导管射频消融（RFCA）治疗术后复发的影响。方法 回顾性连续入选2015年7月至2019年12月行RFCA治疗的男性饮酒房颤患者。收集病史资料和检查结果，以及术后18个月的戒酒情况及房颤随访结果。以Logistic回归分析房颤复发的危险因素。结果 共入选101例患者，术后31例（30.7%）复发。66例（65.3%）戒酒患者房颤复发率明显低于继续饮酒患者（22.7%比45.7%,P=0.017）。多因素Logistic回归分析显示，非阵发性房颤（OR 17.414,95%CI 1.979～153.195,P=0.010）和高血压病（OR 3.638,95%CI 1.348～9.815,P=0.011）为房颤患者术后复发风险增高的独立预测因子，而戒酒为房颤患者术后复发风险降低的独立预测因子（OR 0.241,95%CI 0.088～0.660,P=0.006）。结论 戒酒为男性房颤患者RFCA术后复发风险降低的独立预测因子。

关键词(KeyWords)： 心房颤动;射频消融;酒精;男性;危险因素

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技支撑计划（黔科合支撑[2017]2885）;; 贵州省科学技术厅临床研究中心项目（黔科合平台人才[（2017）5405]）

作者(Author): 夏桂玲,杨龙,杨英,何炯红,郭楚娴,霍照美,田野,刘启方,蒋智,田龙海,黄晶

参考文献(References)：

• [1] Takigawa M,Takahashi A,Kuwahara T,et al. Impact of alcohol consumption on the outcome of catheter ablation in patients with paroxysmal atrial fibrillation[J]. J Am Heart Assoc,2016,5(12):e004149.
• [2] Schreiber D, Rostock T, Fr?hlich M, et al. Five-year followup after catheter ablation of persistent atrial fi brillation using the stepwise approach and prognostic factors for success[J]. Circ Arrhythm Electrophysiol,2015,8(2):308-317.
• [3] Hindricks G,Potpara T,Dagres N,et al. 2020 ESC guidelines for the diagnosis and management of atrial fi brillation developed in collaboration with the European Association f or CardioThoracic Surgery(EACTS):the task force for the diagnosis and management of atrial fi brillation of the European Society of Cardiology(ESC)developed with the special contribution of the European Heart Rhythm Association(EHRA)of the ESC[J].Eur Heart J,2021,42(5):373-498.
• [4]杨泽漫，唐立鸿，黄淑萍. CAAP-AF评分和APPLE评分对心房颤动合并心力衰竭患者导管消融术后复发的预测价值[J].中国介入心脏病学杂志，2020,28(8):430-435.
• [5]贺鹏康，杨颖，范芳芳，等.左心房顺应性参数与阵发性心房颤动射频消融术后复发率相关性分析[J].中国介入心脏病学杂志，2020,28(2):94-101.
• [6] Takahashi Y,Nitta J,Kobori A,et al. Alcohol consumption reduction and clinical outcomes of catheter ablation for atrial fi brillation[J].Circ Arrhythm Electrophysiol, 2021,14(6):e009770.
• [7] Barmano N,Charitakis E,Kronstrand R,et al. The association between alcohol consumption,cardiac biomarkers,lef t atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation[J]. PLoS One,2019,14(4):e0215121.
• [8] Hussein A,Das M,Riva S,et al. Use of ablation index-guided ablation results in high rates of durable pulmonary vein isolation and f reedom f rom arrhythmia in persistent atrial f ibrillation patients:The PRAISE study results[J]. Circ Arrhythm Electrophysiol,2018,11(9):e006576.
• [9] Larsson SC,Drca N,Wolk A. Alcohol consumption and risk of atrial fibrillation:a prospective study and dose-response metaanalysis[J]. J Am Coll Cardiol,2014,64(3):281-289.
• [10] Voskoboinik A,Kalman JM,De Silva A,et al. Alcohol abstinence in drinkers with atrial fi brillation[J]. N Engl J Med,2020,382(1):20-28.
• [11] Samokhvalov AV,Irving HM,Rehm J. Alcohol consumption as a risk factor for atrial fibrillation:a systematic review and meta-analysis[J]. Eur J Cardiovasc Prev Rehabil,2010,17(6):706-712.
• [12] Dixit S,Alonso A,Vittinghoff E,et al. Past alcohol consumption and incident atrial f ibrillation:the Atherosclerosis Risk in Communities(ARIC)study[J]. PLoS One,2017,12(10):e0185228.
• [13] January CT,Wann LS,Alpert JS,et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society[J]. Circulation,2014,130(23):e199-e267.
• [14]中国营养学会.中国居民膳食指南2016[M].人民卫生出版社，2016.
• [15] Di Castelnuovo A,Costanzo S,Bonaccio M,et al. Moderate alcohol consumption is associated with lower risk for heart failure but not atrial fi brillation[J]. JACC Heart Fail,2017,5(11):837-844.
• [16]张志鹏，高连君，张树龙，等.中性粒细胞与淋巴细胞比值对孤立性心房颤动射频消融术后复发的预测价值[J].临床心血管病杂志，2017,33(3):246-250.
• [17] Al-Khalili F,Benson L,Friberg L. Alcohol-related hospitalization is associated with increased risk of ischaemic stroke among lowrisk patients with atrial f ibrillation[J]. Europace,2018,20(1):19-24.
• [18]郭楚娴，杨龙，霍照美，等.饮酒对非瓣膜性心房颤动患者左心耳血栓形成的影响[J].中国介入心脏病学杂志，2021,29(8):442-446.
• [19] Qiao Y,Shi R,Hou B,et al. Impact of alcohol consumption on substrate remodeling and ablation outcome of paroxysmal atrial fi brillation[J]. J Am Heart Assoc,2015,4(11):e002349.
• [20]师睿，姚焰，黄雯，等.饮酒对男性心房颤动患者导管消融疗效的影响[J].中华心律失常学杂志，2012,16(4):297-301,318.
• [21] Voskoboinik A,Wong G,Lee G,et al. Moderate alcohol consumption is associated with atrial electrical and structural changes:Insights from high-density left atrial electroanatomic mapping[J]. Heart Rhythm,2019,16(2):251-259.
• [22] den Uijl DW,Delgado V,Bertini M,et al. Impact of left atrial fi brosis and left atrial size on the outcome of catheter ablation for atrial fi brillation[J]. Heart,2011,97(22):1847-1851.
• [23] McManus DD,Yin X,Gladstone R,et al. Alcohol consumption,left atrial diameter,and atrial fi brillation[J]. J Am Heart Assoc,2016,5(9):e004060.
• [24] Voskoboinik A,Costello BT,Kalman E,et al. Regular alcohol consumption is associated with impaired atrial mechanical function in the atrial fibrillation population:a cross-sectional MRI-based study[J]. JACC Clin Electrophysiol,2018,4(11):1451-1459.
• [25] Zhang H,Ruan H,Rahmutula D,et al. Eff ect of acute and chronic ethanol on atrial fi brillation vulnerability in rats[J]. Heart Rhythm,2020,17(4):654-660.
• [26] Balb?o CE,de Paola AA,Fenelon G. Effects of alcohol on atrial fi brillation:myths and truths[J]. Ther Adv Cardiovasc Dis,2009,3(1):53-63.
• [27] Tanaka A,Cui R,Kitamura A,et al. Heavy alcohol consumption is associated with impaired endothelial function[J]. J Atheroscler Thromb,2016,23(9):1047-1054.
• [28] Rossinen J,Viitasalo M,Partanen J,et al. Eff ects of acute alcohol ingestion on heart rate variability in patients with documented coronary artery disease and stable angina pectoris[J]. Am J Cardiol,1997,79(4):487-491.
• [29] M?ki T,Toivonen L,Koskinen P,et al. Effect of ethanol drinking,hangover,and exercise on adrenergic activity and heart rate variability in patients with a history of alcoholinduced atrial f ibrillation[J]. Am J Cardiol,1998,82(3):317-322.
• [30] Mandyam MC,Vedantham V,Scheinman MM,et al. Alcohol and vagal tone as triggers for paroxysmal atrial fi brillation[J]. Am J Cardiol,2012,110(3):364-368.
• [31] Denison H,Jern S,Jagenburg R,et al. Influence of increased adrenergic activity and magnesium depletion on cardiac rhythm in alcohol withdrawal[J]. Br Heart J,1994,72(6):554-560.
• [32] Khan NA,Hemmelgarn B,Herman RJ,et al. The 2009 Canadian Hypertension Education Program recommendations f or the management of hypertension:Part 2--therapy[J]. Can J Cardiol,2009,25(5):287-298.
• [33] Yan J,Thomson JK,Zhao W,et al. Role of stress kinase JNK in binge alcohol-evoked atrial arrhythmia[J]. J Am Coll Cardiol,2018,71(13):1459-1470.
• [34] Yan J,Thomson JK,Zhao W,et al. The stress kinase JNK regulates gap junction Cx43 gene expression and promotes atrial fi brillation in the aged heart[J]. J Mol Cell Cardiol,2018,114:105-115.
• [35] Hu YF,Chang YT,Lin YJ,et al. The roles of alcohol dehydrogenase in patients with atrial fibrillation[J]. Pacing Clin Electrophysiol,2017,40(12):1446-1453.
• [36] Groh CA,Faulkner M,Getabecha S,et al. Patient-reported triggers of paroxysmal atrial fi brillation[J]. Heart Rhythm,2019,16(7):996-1002.
• [37] Zagrosek A,Messroghli D,Schulz O,et al. Eff ect of binge drinking on the heart as assessed by cardiac magnetic resonance imaging[J].JAMA,2010,304(12):1328-1330.
• [38] Chang TY,Hsiao YW,Guo SM,et al. Resistin as a biomarker for the prediction of left atrial substrate and recurrence in patients with drug-refractory atrial fi brillation undergoing catheter ablation[J]. Int Heart J,2020,61(3):517-523.
• [39] Bai Y,Wang ZZ,Zhang GG,et al. Validating scores predicting atrial fibrillation recurrence post catheter ablation in patients with concurrent atrial fi brillation and pulmonary diseases[J]. Ann Palliat Med,2021,10(4):4299-4307.