阵发性心房颤动导管消融术后复发因素的探讨

发布时间：2019-01-19 18:04

【摘要】：目的探讨阵发性心房颤动患者导管消融术后复发的预测因素。方法入选2010年6月-2013年10月在我院住院的接受三维电解剖标测系统(En-site navx圣犹达公司,美国)指导下行阵发性心房颤动射频消融手术治疗的患者117例,术前采集临床治疗,通过门诊和电话随访至少6月,平均随访时间24.6±2.91(6-46)个月,根据术后房颤是否复发分为复发组和未复发组,并根据同型半胱氨酸水平不同分为正常组、升高组、极高组,观察不同HCY组患者术后6月、12月以及12月后复发率情况,通过分析术前临床资料,并行多因素分析探讨阵发性心房颤动患者射频消融术后复发的预测因素。结果共有117位患者完成术后随访,术后复发共43例(36.75%),组间比较显示体质量指数、合并高血压、房颤病程、左房内径、高密度脂蛋白、尿酸、血浆同型半胱氨酸水平两组间差异有统计学意义。其中复发组的HCY极高组、升高组发生率高与未复发组HCY水平的组间差异有统计学意义(p0.01),术后6个月、12个月以及12月后极高组房颤复发率均高于正常组(p0.05),12月后房颤复发率极高组高于正常组(p0.05),升高组与正常组比较差异无统计学意义,HCY水平与阵发性房颤复发率的相关性分析显示HCY的水平与阵发性房颤复发率呈正相关(r=0.407,p0.05),行多因素Logistic回归分析提示房颤病程(P0.0001;OR:1.031;95%CI:1.016-1.047)、高密度脂蛋白(P=0.028;OR:0.044;95%CI:0.003-0.711)、尿酸(P=0.004;OR:1.009;95%CI:1.003-1.015)、血浆同型半胱氨酸(p=0.003;OR:1.212;95%CI:1.070-1.372)是阵发性房颤患者射频消融术后复发的独立预测因素。结论房颤病程、高密度脂蛋白、血尿酸、血浆同型半胱氨酸是阵发性心房颤动患者射频消融治疗术后复发的预测因素。
[Abstract]:Objective to investigate the prognostic factors of recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Methods A total of 117 patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation were enrolled in our hospital from June 2010 to October 2013, who received three-dimensional electroanatomical mapping system (En-site navx St. Jude, USA) for the treatment of paroxysmal atrial fibrillation. The clinical treatment was collected before operation and followed up at least 6 months by outpatient and telephone. The average follow-up time was 24.6 卤2.91 (6-46) months. According to the recurrence of postoperative atrial fibrillation, the patients were divided into recurrent group and non-recurrence group. According to the level of homocysteine, the patients were divided into normal group, elevated group and extremely high group. The recurrence rate was observed in 6 months, 12 months and 12 months after operation in different HCY groups. The clinical data before operation were analyzed. To investigate the prognostic factors of recurrence after radiofrequency ablation in patients with paroxysmal atrial fibrillation by multivariate analysis. Results A total of 117 patients were followed up and 43 patients (36.75%) had postoperative recurrence. Body mass index (BMI), accompanied with hypertension, course of atrial fibrillation, left atrial diameter, high density lipoprotein (HDL), uric acid were compared between groups. There was significant difference in plasma homocysteine level between the two groups. There was significant difference in the incidence of HCY between the high HCY group and the non-recurrence group (p0.01). The recurrence rate of atrial fibrillation was higher in 6 months, 12 months and 12 months after operation than that in the normal group (p0.05). After 12 months, the recurrence rate of atrial fibrillation in the high group was higher than that in the normal group (p0.05), but there was no significant difference between the elevated group and the normal group. The correlation analysis between HCY level and recurrent rate of paroxysmal atrial fibrillation showed that the level of HCY was positively correlated with the recurrence rate of paroxysmal atrial fibrillation (r = 0.407, p 0.05). Multivariate Logistic regression analysis indicated the course of atrial fibrillation (P 0.0001). High density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047), high density lipoprotein (OR:1.031;95%CI:1.016-1.047). Plasma homocysteine (P 0.003 OR: 1.21295 CI: 1.070-1.372) is an independent predictor of recurrence after radiofrequency ablation in patients with paroxysmal atrial fibrillation. Conclusion the course of atrial fibrillation, high density lipoprotein, serum uric acid and plasma homocysteine are predictors of recurrence after radiofrequency ablation in patients with paroxysmal atrial fibrillation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.75

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