魏统辉,万荣琪,张丁丁,秦晓涵,王佳琪,余嘉奇,孙珂悦,赖晋智,范静波,程中伟,程康安,高鹏,张丽华,邓华,方全,陈太波,刘永太,杨德彦

• 1:中国医学科学院北京协和医学院北京协和医院心内科
• 2:中国医学科学院北京协和医院转化医学国家重大科技基础设施预防与早期干预平台

摘要(Abstract)：

目的 探讨持续性心房颤动（房颤）患者肺静脉隔离术后早期心率变异性与术后12个月内房颤复发的关系。方法 选取2020年9月至2024年7月于中国医学科学院北京协和医院心内科诊断为持续性房颤并接受肺静脉隔离手术的患者。术后即刻对患者进行长程动态心电图监测以评估心率变异性，并随访12个月，分析早期心率变异性与房颤复发的关系。结果 共纳入178例患者，平均年龄63岁，其中男133例（74.7%），术后12个月内房颤复发34例（19.1%，房颤复发组）；房颤未复发144例（80.9%，房颤未复发组）。房颤复发组术前CHA_2DS_2-VASc评分、术后平均心率及心率变异性指标[包括24 h每5分钟所有NN间期标准差的平均值（SDNNIndex）、相邻NN间期差值的均方根（rMSSD）、相邻两个NN间期差值大于50 ms的百分比（pNN50）、低频成分（LF）、高频成分（HF）、低频成分与高频成分的比值（LF/HF）]均显著高于房颤未复发组，差异均有统计学意义（均P<0.05）;24 h每5分钟NN间期平均值的标准差（SDANN）显著低于房颤未复发组，差异有统计学意义（P=0.032）。多因素Cox回归分析显示心率变异性指标SDNNIndex(HR 1.032,95%CI 1.012～1.053,P=0.001)为房颤复发的独立预测因子。根据受试者工作特征（ROC）曲线计算SDNNIndex预测房颤复发的最佳截断值为46 ms，经由Kaplan-Meier生存分析显示SDNNIndex≥46 ms(HR 4.085,95%CI 1.945～8.583,P<0.001)的患者房颤复发率明显升高。结论 持续性房颤患者肺静脉隔离术后早期心率变异性与房颤复发显著相关。

关键词(KeyWords)： 持续性心房颤动;肺静脉隔离;长程监测;心率变异性;心房颤动复发

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院医学与健康科技创新工程（2024-I2M-C&T-B-002、2021-I2M-1-025、2025-I2MC&T-B-006）

作者(Author): 魏统辉,万荣琪,张丁丁,秦晓涵,王佳琪,余嘉奇,孙珂悦,赖晋智,范静波,程中伟,程康安,高鹏,张丽华,邓华,方全,陈太波,刘永太,杨德彦

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