2018 年第 7 期 第 13 卷

心房颤动导管消融术后复发时间对再次消融预后的影响

Effect of atrial fibrillation recurrence time after catheter ablation on the prognosis of redo ablation

作者：郭雪原龙德勇喻荣辉汤日波桑才华蒋晨曦李松南杜昕董建增马长生

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科

英文单位：

关键词：心房颤动；射频消融术；复发时间

英文关键词：

• 摘要：

• 【摘要】目的    探讨心房颤动患者初次导管消融术后复发时间对再次消融预后的影响。方法    连续入选2009年1月至2011年6月于首都医科大学附属北京安贞医院心房颤动中心初次消融后复发接受第2次导管消融的228例患者。根据复发时间将患者分为早期复发组（初次消融后3个月内复发，3个月后仍然有心房颤动发作，128例）、晚期复发组（初次消融后3～12个月复发，59例）、极晚期复发组（初次消融后超过12个月复发，41例）。再次消融术后3、6、12个月和以后每6个月随访1次，比较未服用抗心律失常药物的情况下各组患者窦性心律的维持率。分析初次导管消融术后复发时间对再次消融预后的影响。结果    所有患者再次消融术后平均随访（30±7）个月，在未服用抗心律失常药物的情况下，早期复发组共79例（61.7%）维持窦性心律，晚期复发组44例（74.6%）维持窦性心律，极晚期复发组33例（80.5%）维持窦性心律，极晚期复发组窦性心律维持率明显高于早期复发组和晚期复发组，差异有统计学意义(P=0.038)。单因素Cox回归分析结果显示，持续性心房颤动（风险比=1.600，95%置信区间：1.006～2.542，P=0.047）和极晚期复发（风险比=0.446，95%置信区间：0.211～0.942，P=0.034）与再次消融后心房颤动复发相关。多因素Cox回归分析显示，极晚期复发(风险比=0.448，95%置信区间：0.212～0.946，P=0.035)是再次消融后维持窦性心律的预测因素。结论    心房颤动射频消融术后复发时间显著影响临床预后。与早期复发相比，晚期复发和极晚期复发的患者再次消融后成功率更高。

• 【Abstract】Objective    To investigate the effect of the recurrence time of atrial fibrillation(AF) after initial catheter ablation on the prognosis of redo ablation. Methods    A total of 228 patients undergoing the second time of AF catheter ablation in Beijing Anzhen Hospital, Capital Medical University from January 2009 to June 2011 were consecutively included. According to the recurrence time of AF, the patients were divided into early recurrence group(＜3 months, n=128), late recurrence group(3-12 months, n=59) and extremely late recurrence group(＞12 months, n=41). All patients were followed up 3, 6, 12 months after procedure and every 6 months subsequently beyond 12 months; the maintenance rate of sinus rhythm without antiarrhythmic intervention was observed. The effect of AF recurrence time on the outcome of redo procedure was analyzed. Results    During (30±7)months of follow-up, the maintenance rate of sinus rhythm without antiarrhythmic intervention was 61.7%（n＝79） in early recurrence group, 74.6%（n＝44） in late recurrence group and 80.5%（n＝33） in extremely late recurrence group; the maintenance rate of sinus rhythm in extremely late recurrence group was significantly higher than that in other 2 groups(P=0.038). Univariate Cox analysis showed that persistent AF(hazard rate=1.600, 95% confidence interval: 1.006-2.542, P=0.047) and extremely late recurrence(risk ratio =0.446, 95% confidence interval: 0.211-0.942, P=0.034) were related to the recurrence of AF after redo ablation. Multivariate analysis revealed that extremely late recurrence was an independent predictor of maintenance of sinus rhythm after redo ablation(hazard rate=0.448, 95% confidence interval: 0.212-0.946, P=0.035). Conclusions    The recurrence time of AF after catheter ablation has significant influence on the prognosis of redo ablation. Patients with late AF recurrence may have high success rate of redo ablation.

  【Key words】Atrial fibrillation；Catheter ablation；Recurrence time

  【Fund program】National Natural Science Foundation of China(81500270， 81530016， 81700299)