李景业,杜昕,龙德勇,蒋晨曦,郭雪原,张婷,李新,董建增,马长生

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

目的探讨导管消融与药物治疗对肥厚型心肌病(hypertrophic cardiomyopathy,HCM)合并心房颤动(房颤)患者心血管原因住院率的影响。方法连续入选2004年6月至2015年3月于首都医科大学附属北京安贞医院等7家医院首次接受导管消融治疗的48例HCM合并房颤患者作为导管消融组,纳入同期仅接受药物治疗的78例HCM合并房颤患者作为药物治疗组。随访观察患者房颤复发及心血管原因住院情况。结果导管消融组48例患者均顺利完成房颤导管消融,单次术后平均随访(17.6±8.4)个月,16例(33.3%)复发房颤,32例(66.7%)维持窦性心律;药物治疗组平均随访(10.7±8.0)个月,31例(39.7%)转复为窦性心律;导管消融组患者窦性心律维持率显著高于药物治疗组,差异有统计学意义(P=0.003)。与药物治疗组相比,导管消融组的非计划性心血管原因住院率显著降低[2例(4.2%)比17例(21.8%),P=0.001]。Cox多因素分析显示,房颤治疗策略(导管消融/药物治疗,HR 9.082,95%CI 1.130~73.011,P=0.038)和既往心力衰竭史(HR 2.860,95%CI 1.072~7.633,P=0.036)是非计划性心血管原因住院的独立危险因素。结论 HCM合并房颤组患者导管消融治疗的窦性心律维持率及非计划性心血管原因住院率均优于药物治疗组患者,房颤治疗策略和既往心力衰竭史是非计划性心血管原因住院的独立危险因素。

关键词(KeyWords)： 肥厚型心肌病;心房颤动;导管消融;药物;心血管原因住院

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81470464、81530016);; 北京市医院管理局临床医学发展专项经费资助(ZYLX201302);; 科技部国际合作项目(2013DFB30310)

作者(Author): 李景业,杜昕,龙德勇,蒋晨曦,郭雪原,张婷,李新,董建增,马长生

参考文献(References)：

• [1]Authors/Task Force M,Elliott PM,Anastasakis A,et al.2014ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC).Eur Heart J,2014,35(39):2733-2779.
• [2]Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Developed in collaboration with the American Association for Thoracic Surgery,American Society of Echocardiography,American Society of Nuclear Cardiology,Heart Failure Society of America,Heart Rhythm Society,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons.J Am Coll Cardiol,2011,58(25):e212-e260.
• [3]Bunch TJ,Munger TM,Friedman PA,et al.Substrate and procedural predictors of outcomes after catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy.J Cardiovasc Electrophysiol,2008,19(10):1009-1014.
• [4]马长生,刘少伟.心力衰竭合并心房颤动的治疗策略进展.内科理论与实践,2014,9(1):11-15.
• [5]Dong JZ,Sang CH,Yu RH,et al.Prospective randomized comparison between a fixed'2C3L'approach vs.stepwise approach for catheter ablation of persistent atrial fibrillation.Europace,2015,17(12):1798-1806.
• [6]Tian T,Wang Y,Sun K,et al.Clinical profile and prognostic significance of atrial fibrillation in hypertrophic cardiomyopathy.Cardiology,2013,126(4):258-264.
• [7]Tani T,Yagi T,Kitai T,et al.Left atrial volume predicts adverse cardiac and cerebrovascular events in patients with hypertrophic cardiomyopathy.Cardiovasc Ultrasound,2011,9:34.
• [8]Siontis KC,Geske JB,Ong K,et al.Atrial fibrillation in hypertrophic cardiomyopathy:prevalence,clinical correlations,and mortality in a large high-risk population.J Am Heart Assoc,2014,3(3):e001002.
• [9]Olivotto I,Cecchi F,Casey SA,et al.Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy.Circulation,2001,104(21):2517-2524.
• [10]宋月洁,姜腾勇,任学军,等.心房颤动对肥厚型心肌病患者长期预后的影响.中华实用诊断与治疗杂志,2013,27(2):126-128.
• [11]Guttmann OP,Rahman MS,O'Mahony C,et al.Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy:systematic review.Heart,2014,100(6):465-472.
• [12]Kubo T,Kitaoka H,Okawa M,et al.Clinical impact of atrial fibrillation in patients with hypertrophic cardiomyopathy.Results from Kochi RYOMA Study.Circ J,2009,73(9):1599-1605.
• [13]Nistri S,Olivotto I,Maron MS,et al.βBlockers for prevention of exercise-induced left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy.Am J Cardiol,2012,110(5):715-719.
• [14]Zhao DS,Shen Y,Zhang Q,et al.Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy:a systematic review and meta-analysis.Europace,2016,18(4):508-520.
• [15]Ha HS,Wang N,Wong S,et al.Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy patients:a systematic review.J Interv Card Electrophysiol,2015,44(2):161-170.
• [16]Ejima K,Shoda M,Arai K,et al.Impact of diastolic dysfunction on the outcome of catheter ablation in patients with atrial fibrillation.Int J Cardiol,2013,164(1):88-93.
• [17]Santangeli P,Di Biase L,Themistoclakis S,et al.Catheter ablation of atrial fibrillation in hypertrophic cardiomyopathy:long-term outcomes and mechanisms of arrhythmia recurrence.Circ Arrhythm Electrophysiol,2013,6(6):1089-1094.
• [18]Ganesan AN,Shipp NJ,Brooks AG,et al.Long-term outcomes of catheter ablation of atrial fibrillation:a systematic review and meta-analysis.J Am Heart Assoc,2013,2(2):e004549.
• [19]Contreras-Valdes FM,Buxton AE,Josephson ME,et al.Atrial fibrillation ablation in patients with hypertrophic cardiomyopathy:long-term outcomes and clinical predictors.J Am Coll Cardiol,2015,65(14):1485-1487.
• [20]Gaita F,Di Donna P,Olivotto I,et al.Usefulness and safety of transcatheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy.Am J Cardiol,2007,99(11):1575-1581.
• [21]Sciagra R,Sotgia B,Olivotto I,et al.Relationship between atrial fibrillation and blunted hyperemic myocardial blood flow in patients with hypertrophic cardiomyopathy.J Nucl Cardiol,2009,16(1):92-96.
• [22]Bassiouny M,Lindsay BD,Lever H,et al.Outcomes of nonpharmacologic treatment of atrial fibrillation in patients with hypertrophic cardiomyopathy.Heart Rhythm,2015,12(7):1438-1447.
• [23]Di Donna P,Olivotto I,DelcrèSD,et al.Efficacy of catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy:impact of age,atrial remodelling,and disease progression.Europace,2010,12(3):347-355.