导管消融对阵发性心房颤动合并病态窦房结综合征患者的影响——非肺静脉起源灶的重要作用。
Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome - Important Role of Non-Pulmonary Vein Foci.
作者信息
Hayashi Kentaro, Fukunaga Masato, Yamaji Kyohei, An Yoshimori, Nagashima Michio, Hiroshima Kenichi, Ohe Masatsugu, Makihara Yu, Yamashita Kennosuke, Ando Kenji, Iwabuchi Masashi, Goya Masahiko
机构信息
Department of Cardiology, Kokura Memorial Hospital.
出版信息
Circ J. 2016;80(4):887-94. doi: 10.1253/circj.CJ-15-1384. Epub 2016 Mar 2.
BACKGROUND
The clinical efficacy of catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) and the mechanism and predictors of recurrence are not yet completely elucidated.
METHODS AND RESULTS
Of 963 consecutive patients who underwent PAF ablation during the study period, a total of 108 patients with SSS (SSS group) and 108 matched controls without SSS (non-SSS group) were followed up. During the follow-up period (mean, 32.8±17.5 months), the SSS group had significantly higher AF recurrence rate since the last procedure than the non-SSS group (26.9% vs. 12.0%; P=0.02). The SSS group had significantly higher prevalence of non-pulmonary vein (non-PV) foci than the non-SSS group (25.9% vs. 13.9%; P=0.027). On multivariate analysis congestive heart failure (HR, 13.7; 95% CI: 1.57-119; P=0.02) and non-PV foci (HR, 5.75; 95% CI: 1.69-19.6; P=0.005) were independent predictors of recurrence following CA in the SSS group. In the SSS group, 88 patients had bradycardia-tachycardia syndrome without prior permanent pacemaker implantation. Of these, 6 required pacemaker implantation because of AF and sinus pause recurrence.
CONCLUSIONS
Patients with SSS are at higher risk of AF recurrence after CA. Non-PV foci are associated with AF recurrence following PAF with SSS.
背景
对于病态窦房结综合征（SSS）患者，导管消融（CA）治疗阵发性心房颤动（PAF）的临床疗效以及复发机制和预测因素尚未完全阐明。
方法与结果
在研究期间连续接受PAF消融的963例患者中，共对108例SSS患者（SSS组）和108例匹配的无SSS对照患者（非SSS组）进行了随访。在随访期（平均32.8±17.5个月），SSS组自上次手术以来的房颤复发率显著高于非SSS组（26.9%对12.0%；P=0.02）。SSS组非肺静脉（非PV）病灶的患病率显著高于非SSS组（25.9%对13.9%；P=0.027）。多因素分析显示，充血性心力衰竭（HR，13.7；95%CI：1.57 - 119；P=0.02）和非PV病灶（HR，5.75；95%CI：1.69 - 19.6；P=0.005）是SSS组CA术后复发的独立预测因素。在SSS组中，88例患者有心动过缓 - 心动过速综合征且未预先植入永久性起搏器。其中，6例因房颤和窦性停搏复发而需要植入起搏器。
结论
SSS患者CA术后房颤复发风险较高。非PV病灶与SSS患者PAF术后房颤复发相关。
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