Zhang Hong-Da, Ding Lei, Weng Si-Xian, Zhou Bin, Ding Xiao-Tong, Hu Li-Xing, Qi Ying-Jie, Yu Feng-Yuan, Feng Tian-Jie, Zhang Jing-Tao, Fang Pi-Hua, Hua Wei, Zhang Shu, Tang Min
Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2021 Nov 12;8:766571. doi: 10.3389/fcvm.2021.766571. eCollection 2021.
A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated. We retrospectively enrolled 101 consecutive patients with HCM who were referred to the electrophysiology and arrhythmia service from May 2010 to October 2020. The clinical features and ablation outcomes were analyzed. Seventy-eight patients had SVAs, which comprised 50 (64.1%) cases of atrial fibrillation (AF), 16 (20.5%) of atrial flutter (AFL), 15 (19.2%) of atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) of atrial arrhythmia (AT), and 3 (3.8%) of atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation and were followed up for a median (interquartile range) of 58.5 (82.9) months. There was no recurrence in patients with non-AF SVAs. In patients with AF, the 1- and 7-year AF-free survival rates were 87.5 and 49.5%, respectively. A receiver operator characteristic analysis showed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with a higher recurrence of AF, with an optimum cutoff value of 47 mm (c-statistic = 0.91, = 0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan-Meier analysis, patients with a LVEDD ≥ 47 mm had worse AF-free survival than those with a LVEDD <47 mm (log-rank = 0.014). In this unique population of HCM, AF was the most common SVA, followed in order by AFL, AVRT, AT, and AVNRT. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfactory. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.
肥厚型心肌病（HCM）患者可能会出现多种室上性心律失常（SVA）。不同类型的HCM患者SVA的特征及长期消融结果尚未得到全面研究。我们回顾性纳入了2010年5月至2020年10月间连续转诊至电生理和心律失常门诊的101例HCM患者。分析其临床特征及消融结果。78例患者发生SVA，其中50例（64.1%）为心房颤动（AF），16例（20.5%）为心房扑动（AFL），15例（19.2%）为房室折返性心动过速（AVRT），11例（14.1%）为房性心律失常（AT），3例（3.8%）为房室结折返性心动过速（AVNRT）。34例患者接受了导管消融，并进行了中位（四分位间距）58.5（82.9）个月的随访。非AF SVA患者无复发。AF患者1年和7年无AF生存率分别为87.5%和49.5%。受试者工作特征分析显示，左心室舒张末期内径（LVEDD）越大，AF复发率越高，最佳截断值为47 mm（c统计量 = 0.91，P = 0.011，敏感性 = 1.00，特异性 = 0.82）。在Kaplan-Meier分析中，LVEDD≥47 mm的患者无AF生存率低于LVEDD<47 mm的患者（对数秩检验P = 0.014）。在这个独特的HCM患者群体中，AF是最常见的SVA，其次依次为AFL、AVRT、AT和AVNRT。HCM患者非AF SVA的长期导管消融结果令人满意。较大的LVEDD可预测HCM患者导管消融后AF复发。
