导管消融与药物治疗对肥厚型心肌病合并心房颤动患者心血管原因住院率的影响

发布时间：2018-03-04 00:14

本文选题：肥厚型心肌病　切入点：心房颤动　出处：《中国介入心脏病学杂志》2016年10期 　论文类型：期刊论文

【摘要】：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。
[Abstract]:Objective to investigate the effect of catheter ablation and drug therapy on cardiovascular hospitalization rate in patients with hypertrophic cardiomyopathy HCM and atrial fibrillation (AF). For the first time, 48 patients with HCM complicated with atrial fibrillation in 7 hospitals, including Beijing Anzhen Hospital, were treated with catheter ablation for the first time. 78 HCM patients with atrial fibrillation were enrolled as drug therapy group. The recurrence of atrial fibrillation and hospitalization of cardiovascular causes were observed. Results 48 patients in catheter ablation group completed atrial fibrillation catheter ablation successfully. The average follow-up time was 17.6 卤8.4 months (16 cases, 33.33.3)) 32 patients with recurrent atrial fibrillation (66.7%) maintained sinus rhythm, 31 patients with drug therapy (10.7 卤8.0 months), 31 cases with sinus rhythm, the sinus rhythm rate of catheter ablation group was significantly higher than that of drug therapy group, the average follow-up time was 10.7 卤8.0 months (39.7%), and the rate of sinus rhythm in catheter ablation group was significantly higher than that in drug therapy group, and the rate of sinus rhythm was significantly higher in the catheter ablation group than in the drug therapy group. Compared with the drug therapy group, the hospitalization rate of non-planned cardiovascular causes in the catheter ablation group was significantly lower than that in the 17 patients (2 / 4.2). Cox multivariate analysis showed that the incidence of non-planned cardiovascular disease in the catheter ablation group was significantly lower than that in the control group (P < 0.05), and that in the catheter ablation group was significantly lower than that in the control group (n = 17). The treatment strategy of atrial fibrillation (HR 9.082 ~ 9595 CI 1.130 CI 1.130 ~ 73.011) and previous history of heart failure (HR 2.8602 / 7.633) is an independent risk factor for hospitalization of unplanned cardiovascular causes. Conclusion Sinus in patients with HCM with atrial fibrillation is associated with catheter ablation. The maintenance rate of cardiac rhythm and the hospitalization rate of unplanned cardiovascular causes were better than those of drug treatment group. Treatment strategies for atrial fibrillation and unplanned cardiovascular hospitalization with past heart failure are independent risk factors.
【作者单位】：首都医科大学附属北京安贞医院心内科;
【基金】：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)
【分类号】：R541.75;R542.2

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