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右束支阻滞或室内传导延迟与导管消融后心房颤动复发的关系。

Association of right bundle branch block or intraventricular conduction delay with recurrence of atrial fibrillation after catheter ablation.

机构信息

Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.

出版信息

Ann Noninvasive Electrocardiol. 2023 Nov;28(6):e13083. doi: 10.1111/anec.13083. Epub 2023 Sep 10.

Abstract

BACKGROUND

The association between bundle branch block (BBB) and recurrence of atrial fibrillation (AF) after catheter ablation is unclear. The aim of this study was to determine whether AF combined with BBB is associated with AF recurrence after catheter ablation.

METHODS

A total of 477 consecutive AF patients who underwent catheter ablation were included. The AF patients were divided into three groups according to BBB: AF without BBB (n = 427), AF with right bundle branch block (AF with RBBB) (n = 16), and AF with intraventricular conduction delay (AF with IVCD) (n = 34).

RESULTS

Of the 477 AF patients (mean age 57 years, 81% men, median CHA DS -VASc score of 1), 16 (3.4%) patients had RBBB, and 34 (7.1%) patients had IVCD. During a mean follow-up of 15.2 ± 6.7 months, 119 patients (24.9%) had recurrence of AF. Of these, 111 (26%) patients were in the AF without BBB group, with 2 (12.5%) and 6 (17.6%) patients in the RBBB and IVCD groups, respectively. The Kaplan-Meier estimate of the rate of recurrent AF was not significantly different among the three groups (p = .39). Multivariable analysis showed that persistent AF (HR 1.7, 95% CI 1.15-2.50, p = .007), chronic kidney disease (HR 2.94, 95% CI 1.20-7.17, p = .01), and left atrial diameter (HR 1.04, 95% CI 1.009-1.082, p = .01) were significantly associated with AF recurrence.

CONCLUSION

AF with BBB was not significantly associated with the recurrence of AF after catheter ablation in middle-aged patients with low-risk cardiovascular profile.

摘要

背景

束支传导阻滞(BBB)与导管消融后心房颤动(AF)复发的关系尚不清楚。本研究旨在确定 AF 合并 BBB 是否与导管消融后 AF 复发相关。

方法

共纳入 477 例连续接受导管消融的 AF 患者。根据 BBB 将 AF 患者分为三组:无 BBB 的 AF(n=427)、伴有右束支传导阻滞的 AF(伴有 RBBB,n=16)和伴有室内传导延迟的 AF(伴有 IVCD,n=34)。

结果

在 477 例 AF 患者(平均年龄 57 岁,81%为男性,中位 CHA2DS2-VASc 评分为 1)中,16 例(3.4%)患者存在 RBBB,34 例(7.1%)患者存在 IVCD。在平均 15.2±6.7 个月的随访中,119 例(24.9%)患者出现 AF 复发。其中,111 例(26%)患者在无 BBB 的 AF 组,RBBB 组分别有 2 例(12.5%)和 6 例(17.6%),IVCD 组分别有 2 例(12.5%)和 6 例(17.6%)。三组间复发 AF 的 Kaplan-Meier 估计率无显著差异(p=0.39)。多变量分析显示,持续性 AF(HR 1.7,95%CI 1.15-2.50,p=0.007)、慢性肾脏病(HR 2.94,95%CI 1.20-7.17,p=0.01)和左心房直径(HR 1.04,95%CI 1.009-1.082,p=0.01)与 AF 复发显著相关。

结论

在心血管风险低危的中年患者中,BBB 合并 AF 与导管消融后 AF 复发无显著相关性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3421/10646381/a43bcdd8f505/ANEC-28-e13083-g002.jpg

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