肥厚型心肌病合并心房颤动患者导管消融术后心房颤动复发的预测因素

[Predictors of atrial fibrillation recurrence after catheter ablation in hypertrophic cardiomyopathy patients with atrial fibrillation].

作者信息

Wen Songnan, Liu Nian, Li Songnan, Ning Man, Kang Junping, Wu Jiahui, Ruan Yanfei, Jiang Chenxi, Sang Caihua, Tang Ribo, Long Deyong, Yu Ronghui, Bai Rong, Du Xin, Hu Rong, Dong Jianzeng, Liu Xiaohui, Ma Changsheng

机构信息

National Clinical Research Center for Cardiovascular Diseases; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

National Clinical Research Center for Cardiovascular Diseases; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; Email:

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2015 Jul;43(7):589-94.

PMID:26420318

Abstract

OBJECTIVE

To evaluate the efficacy of catheter ablation in Chinese hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF), and to determine the risk factors of AF recurrence.

METHODS

This study enrolled 40 HCM patients with AF who underwent primary AF ablation at Beijing Anzhen Hospital from June 2005 to June 2013. Ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n = 27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n = 13). AF recurrence was followed-up by means of electrocardiography or Holter monitoring. Risk factors associated with AF recurrence were determined by a Cox regression model and the predictive power was evaluated by receiver operating characteristic (ROC) curve.

RESULTS

After (34 ± 18) months follow-up, 30% (12/40) cases remained in sinus rhythm off antiarrhythmic drug, most AF recurrence (18/28, 64.3%) occurred within 1 year post ablation. Multivariate Cox regression demonstrated that left atrial dimension (LAD, HR = 1.124, 95% CI 1.051-1.202, P = 0.001) and female gender (HR = 3.304, 95% CI 1.397-7.817, P = 0.007) were independent risk factors of AF recurrence. The cut-off value of LAD at 43.5 mm predicted AF recurrence with sensitivity of 93.5% and specificity of 60.0%. Every 1 mm enlargement in LAD was associated with an increased risk of arrhythmia recurrence (HR = 1.095, 95% CI 1.031-1.163, P = 0.003).

CONCLUSIONS

AF ablation in Chinese HCM patients is safe and feasible. However, sinus rhythm maintenance rate is low at long-time follow-up. Most of the recurrent AF occurs within 1 year post AF ablation procedure. Left atrial diameter and female gender are independent risk factors of AF recurrence.

摘要

目的

评估导管消融术对中国肥厚型心肌病（HCM）合并心房颤动（AF）患者的疗效，并确定房颤复发的危险因素。

方法

本研究纳入了2005年6月至2013年6月在北京安贞医院接受初次房颤消融的40例HCM合并AF患者。消融策略包括对阵发性房颤患者行双侧肺静脉隔离（PVI，n = 27），对持续性房颤患者行PVI加左心房顶部、二尖瓣峡部和三尖瓣峡部线性消融（n = 13）。通过心电图或动态心电图监测随访房颤复发情况。采用Cox回归模型确定与房颤复发相关的危险因素，并通过受试者工作特征（ROC）曲线评估预测能力。

结果

经过（34±18）个月的随访，30%（12/40）的患者在停用抗心律失常药物后维持窦性心律，大多数房颤复发（18/28，64.3%）发生在消融术后1年内。多因素Cox回归分析显示，左心房内径（LAD，HR = 1.124，95%CI 1.051 - 1.202，P = 0.001）和女性性别（HR = 3.304，95%CI 1.397 - 7.817，P = 0.007）是房颤复发的独立危险因素。LAD的截断值为43.5 mm时预测房颤复发的敏感性为93.5%，特异性为60.0%。LAD每增大1 mm，心律失常复发风险增加（HR = 1.095，95%CI 1.031 - 1.163，P = 0.003）。