迷走神经张力增高型、肾上腺素能型及随机型阵发性心房颤动对左心房消融结果的影响。

The impact of vagotonic, adrenergic, and random type of paroxysmal atrial fibrillation on left atrial ablation outcomes.

作者信息

Efremidis Michael, Letsas Konstantinos P, Lioni Louiza, Deftereos Spyridon, Giannopoulos Georgios, Kossyvakis Charalampos, Tsikrikas Spyros, Charalampous Charalampos, Kollias George, Xydonas Sotirios, Synetos Andreas, Sideris Antonios, Toutouzas Konstantinos, Stefanadis Christodoulos

机构信息

2(nd) Department of Cardiology, Evangelismos General Hospital, Athens, Greece.

出版信息

Int J Cardiol. 2013 Oct 9;168(4):4015-8. doi: 10.1016/j.ijcard.2013.06.075. Epub 2013 Jul 17.

DOI:10.1016/j.ijcard.2013.06.075

PMID:23870637

Abstract

BACKGROUND

Accumulating data have shown that the autonomic nervous system is strongly implicated in the genesis of atrial fibrillation (AF). The aim of this study was to assess the efficacy of a single ablation procedure in patients with vagotonic, adrenergic and random type of paroxysmal AF.

METHODS AND RESULTS

The clinical records of consecutive patients with symptomatic, drug-refractory paroxysmal AF who underwent pulmonary vein antral isolation were analysed. The study population consisted of 104 patients (64 males, mean age 57.9 ± 10.9 years) with paroxysmal AF. Based on AF triggers, patients were classified in those with vagotonic (31.7%), adrenergic (17.3%) and random AF (51%). Subjects with adrenergic and random AF tended to be older (p: 0.104) and displayed a higher incidence of hypertension (p: 0.088) compared with those with vagotonic AF. Following a mean follow-up period of 14.7 ± 7.4 months, 74 patients were free from arrhythmia recurrence (71.2%). Late arrhythmia recurrence (>3 months from the index procedure) occurred in 33.3%, 16.7% and 30.2% of patients with vagotonic, adrenergic and random AF, respectively (p: 0.434). Cox regression analysis showed that early AF recurrence [hazard ratio (HR) 15.76; 95% confidence interval (CI) 5.456-45.566, p: <0.001], left atrial volume (HR 0.969; 95% CI 0.942-0.996, p: 0.025) and statin use (HR 6.828; 95% CI 2.078-22.437 p: 0.002) were independent predictors of late arrhythmia recurrence.

CONCLUSIONS

In this study cohort, the type of paroxysmal AF was not associated with arrhythmia recurrence following left atrial ablation.

摘要

背景

越来越多的数据表明，自主神经系统与心房颤动（房颤）的发生密切相关。本研究的目的是评估单次消融手术对阵发性房颤的迷走神经型、肾上腺素能型和随机型患者的疗效。

方法与结果

分析了连续接受肺静脉前庭隔离术的有症状、药物难治性阵发性房颤患者的临床记录。研究人群包括104例阵发性房颤患者（64例男性，平均年龄57.9±10.9岁）。根据房颤触发因素，患者分为迷走神经型（31.7%）、肾上腺素能型（17.3%）和随机型房颤（51%）。与迷走神经型房颤患者相比，肾上腺素能型和随机型房颤患者往往年龄更大（p：0.104），高血压发病率更高（p：0.088）。平均随访14.7±7.4个月后，74例患者无心律失常复发（71.2%）。迷走神经型、肾上腺素能型和随机型房颤患者的晚期心律失常复发（距首次手术>3个月）分别为33.3%、16.7%和30.2%（p：0.434）。Cox回归分析显示，早期房颤复发[风险比（HR）15.76；95%置信区间（CI）5.456 - 45.566，p：<0.001]、左心房容积（HR 0.969；95%CI 0.942 - 0.996，p：0.025）和他汀类药物使用（HR 6.828；95%CI 2.078 - 22.437，p：0.002）是晚期心律失常复发的独立预测因素。