[心房颤动患者肺静脉隔离术后无症状性房性快速心律失常复发]

[Asymptomatic recurrence of atrial tachy-arrhythmia after circumferential pulmonary vein isolation in patients with atrial fibrillation].

作者信息

Hao Peng, Ma Chang-sheng, Dong Jian-zeng, Liu Xing-peng, Long De-yong, Fang Dong-ping, Hu Fu-li, Yu Rong-hui, Tang Ri-bo, Lu Chun-shan, Liu Xiao-hui

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2007 Jun 26;87(24):1669-72.

PMID:17825144

Abstract

OBJECTIVE

To investigate the incidence, type, and predictors of asymptomatic relapse of atrial tachy-arrhythmia (ATa) after circumferential pulmonary vein isolation (CPVI) in patients with atrial fibrillation (AF).

METHODS

Forty-eight consecutive patients with AF underwent CPVI and were followed up. Forty-eight hours Holter recording was performed 1, 3, and 6 months respectively after the initial CPVI procedure. Predictors of asymptomatic ATa relapse were determined by Logistic regression analysis for eight variables as follows: age, gender, AF type, existence of organic heart disease, diameter of left atria, left ventricular ejection fraction, procedure time, and heart rate variability after the procedure.

RESULTS

Complete Holter data were acquired in 42 patients, 26 males and 16 females, aged: 58 +/- 14, including 25 patients with paroxysmal AF and 17 with non-paroxysmal AF. The standard deviations of R-R interval (SDNN) of the non-paroxysmal AF group was 92 ms +/- 19 ms, significantly longer than that of the paroxysmal AF group (78 ms +/- 15 ms, P = 0.011). The incidence of asymptomatic ATa recurrence rates 1, 3 and 6 months after CPVI were 8%, 12%, and 8% respectively in paroxysmal AF group and 23.5%, 29.4%, and 35.3% respectively in the non-paroxysmal AF group. The incidence of asymptomatic ATa recurrence 6 months after CPVI in the non-paroxysmal AF group was significant higher than that in the paroxysmal AF group (P < 0.05). AF was the dominant arrhythmia among the asymptomatic recurrence ATa, while atrial tachycardia constituted the major arrhythmia of the symptomatic recurrent ATa.

CONCLUSION

(1) Asymptomatic ATa relapse is common among the patients undergoing CPVI. (2) The dominant type of asymptomatic recurrent arrhythmia is AF. (3) The independent predictors for asymptomatic ATa recurrence include non-paroxysmal AF, left atrial enlargement, and increase of SDNN.

摘要

目的

探讨心房颤动（AF）患者行环肺静脉隔离术（CPVI）后房性快速心律失常（ATa）无症状复发的发生率、类型及预测因素。

方法

连续48例AF患者接受CPVI并进行随访。在初次CPVI术后1、3和6个月分别进行48小时动态心电图记录。通过对以下8个变量进行Logistic回归分析确定无症状ATa复发的预测因素：年龄、性别、AF类型、器质性心脏病的存在、左心房直径、左心室射血分数、手术时间以及术后心率变异性。

结果

42例患者获得完整的动态心电图数据，其中男性26例，女性16例，年龄：58±14岁，包括25例阵发性AF患者和17例非阵发性AF患者。非阵发性AF组的R-R间期标准差（SDNN）为92 ms±19 ms，显著长于阵发性AF组（78 ms±15 ms，P = 0.011）。阵发性AF组CPVI术后1、3和6个月无症状ATa复发率分别为8%、12%和8%，非阵发性AF组分别为23.5%、29.4%和35.3%。非阵发性AF组CPVI术后6个月无症状ATa复发率显著高于阵发性AF组（P < 0.05）。在无症状复发的ATa中AF是主要心律失常，而在有症状复发的ATa中房性心动过速是主要心律失常。