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论著:心房颤动射频消融术中出现规律性快速性房性心律失常的预测因素
Predictors of Regular Atrial Tachyarrhythmias in Patients with Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation
陈松文 刘少稳 林佳雄 聂振宁 吴鸿谊 程宽 陶惠伟 周京敏 葛均波
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作者单位:上海交通大学附属第一人民医院心内科
中文关键字:心房颤动;心房扑动;房性心动过速;规律性快速性房性心律失常;预测因素
英文关键字:Atrial fibrillation; Atrial flutter; Atrial tachycardia; Regular atrial tachyarrhythmias; Predictors
中文摘要:目的:分析心房颤动(简称房颤)经导管射频消融术中出现心房扑动、房性心动过速等规律性快速性房性心律失常(RATs)的预测因素。方法:首次行经导管射频消融治疗的497例房颤患者(阵发性房颤333例,持续性和(或)永久性房颤164例)在三维标测系统及环状标测电极导管指导下行经导管射频消融治疗(包括环肺静脉电隔离、线性消融和(或)碎裂电位消融)。术中记录RATs的发生情况,并分析RATs的可能影响因素。结果:术中共有163例患者[32.8%;阵发性房颤92例,持续性和(或)永久性房颤71例]出现195种RATs,持续性和(或)永久性房颤术中RATs的发生率显著高于阵发性房颤(43.3%比27.6%, P<0.001)。单因素分析发现心脏外科术后(P<0.001)、术前有RATs(P=0.010)、持续性和(或)永久性房颤(P<0.001)、左房内径增大(P<0.001)、左室射血分数降低(P=0.018)是房颤术中出现RATs的影响因素。Logistic多因素回归分析发现心脏外科术后[优势比(OR)=8.14,95%可信区间(CI):1.69 ~ 39.1,P=0.009]、术前有RATs[OR=2.15,95%CI:1.35 ~ 3.42,P=0.001] 、持续性和(或)永久性房颤[OR=1.71,95%CI:1.06 ~ 2.76,P=0.029]、左房内径 [OR=1.04,95%CI:1.01 ~ 1.08,P=0.025]是术中出现RATs的独立预测因素。结论:房颤射频消融术中常出现RATs,心脏外科术后、术前有RATs、持续性和(或)永久性房颤、左房内径是术中出现RATs的独立预测因素。
英文摘要:Objective: To investigate the predictors of regular atrial tachyarrhythmias (RATs, including atrial flutter and atrial tachycardia) during operation in patients with atrial fibrillation (AF) who underwent radiofrequency catheter ablation(RFCA).Methods: A total of 497 consecutive patients with AF, who underwent RFCA for the first time guided by a three-dimensional mapping system and a circular mapping catheter, were included in this study. The ablation strategy included circumferential pulmonary veins isolation (CPVI), linear ablation and/or complex fractionated atrial electrograms ablation. RATs during ablation were recorded and those factors which maybe associated with RATs were analyzed.Results: RATs were indentified in 163 patients(32.8%, paroxysmal AF 92, persistent/permanent AF 71), the incidence of RATs in persistent/permanent AF was higher than that of paroxysmal AF (43.3% vs. 27.6%, P<0.001)。Left atrial diameter (LAD, P<0.001), lower left ventricular ejection fraction (P=0.018), persistent/permanent AF (P<0.001), a history of RATs before ablation (P=0.010) and post cardiac surgery (PCS, P<0.001) were identified as predictors of RATs by univariate analysis. PCS [odd ratio (OR)=8.14, 95% confidence interval (CI): 1.69-39.1,P=0.009], a history of RATs [OR=2.15, 95% CI: 1.35-3.42, P=0.001], persistent/permanent AF [OR=1.71, 95% CI: 1.06-2.76, P=0.029], LAD [OR=1.04, 95% CI: 1.01-1.08, P=0.025], revealed by Logistic regression analysis, were those independent predictors of RATs.Conclusions: RATs are common during AF ablation. PCS, a history of RATs, persistent/permanent AF and LAD are those independent predictors of RATs.
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