术中消融终止对长程持续性房颤“Stepwise”消融策略预后的影响
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(首都医科大学附属北京安贞医院心律失常中心,北京市 100000)

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刘佟,博士,主治医师,研究方向为心律失常的基础与临床,E-mail:liutong03@126.com。

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国家自然科学基金面上项目(82070339、82151306)


The impact of intraoperative ablation termination on the prognosis of “Stepwise” ablation strategy for long-standing persistent atrial fibrillation
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Arrhythmia Center of Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100000, China)

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    摘要:

    目的]探讨长程持续性房颤(LSPAF)行“Stepwise”消融过程中消融终止对患者窦性心律维持的影响。 [方法]连续纳入260例LSPAF患者,采用“Stepwise”消融策略,并收集相关临床资料。根据消融结果,将患者分为消融终止组和电复律组。采用亚组分析术中转为心房扑动(AFL)及消融终止的预后价值,随访1年,探讨其对预后的影响。 [结果]103例(39.6%)LSPAF行“Stepwise”消融过程中自行终止。与电复律组相比,消融终止组的心房颤动(简称房颤)病程、左心房内径显著降低(均P<0.05)。随访1年发现,45例(17.3%)患者复发,两组间的复发占比差异无统计学意义(均P>0.05)。亚组分析发现,AFL的转化和消融终止与远期窦性心律维持相关(均P<0.05)。多因素Cox回归分析显示,房颤病程、体质指数、左心房内径和空腹血糖是复发的独立危险因素。 [结论]约39.6%的LSPAF在“Stepwise”消融过程中恢复窦性心律,但与远期窦性心律维持无相关性。消融期间转为AFL后消融终止对远期窦性心律的维持具有预测作用。

    Abstract:

    Aim To explore the impact of ablation termination on the maintenance of sinus rhythm in long-standing persistent atrial fibrillation (LSPAF) by “Stepwise” ablation strategy. Methods This study involved 260 LSPAF patients who underwent “Stepwise” ablation strategy and clinical characteristics were collected. According to the ablation procedure, the patients were divided into ablation termination group and cardioversion group. The prognostic value of conversion to atrial flutter (AFL) and ablation termination was analyzed using subgroup analysis, followed up for 1 year to explore their impact on prognosis. Results Overall, 103 (39.6%) cases of LSPAF were terminated by ablation. Compared to the cardioversion group, the courses of atrial fibrillation and left atrial diameter were lower in the ablation termination group (all P<0.05). At 1 year of follow-up, 45 (17.3%) patients had experienced recurrence, with no statistical difference in the proportion of recurrence between the two groups (all P>0.05). Compared to preoperative, left atrial diameter was significantly lower after 1 year regardless of recurrence. In subgroup analysis, conversion to AFL and ablation termination was associated with the maintenance of long-term sinus rhythm (all P<0.05). On multivariable Cox regression, the courses of atrial fibrillation, body mass index, left atrial diameter and fasting blood glucose were independent risk factors for recurrence. Conclusions 39.6% of LSPAF recovered sinus rhythm during the “Stepwise” ablation process, but there was no correlation with long-term sinus rhythm maintenance. Termination of ablation after conversion to AFL during ablation has a predictive effect on the maintenance of long-term sinus rhythm.

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刘佟,杨扬,龙德勇.术中消融终止对长程持续性房颤“Stepwise”消融策略预后的影响[J].中国动脉硬化杂志,2024,32(10):857~864.

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  • 收稿日期:2024-06-19
  • 最后修改日期:2024-08-10
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  • 在线发布日期: 2024-10-22