心脏再同步治疗术后新发心房颤动与窦性心律的对比分析

目的 分析心脏再同步治疗（CRT）术后1年内慢性心力衰竭（CHF）患者出现新发心房颤动（房颤）与保持窦性心律的疗效对比情况.方法 接受CRT治疗CHF患者54例,所有患者术前均无房颤病史,于术前和术后6、12个月进行程控随访及临床、超声心动图检查.结果 1年随访结束时,54例患者中有12例（22.2%）出现新发房颤,其余42例保持窦性心律.窦性心律组术后临床及超声心动图指标均较术前明显改善（P＜0.001）.新发房颤组术后心功能、左心室射血分数（LVEF）、左心室舒张末内径也较术前有明显改善（P＜0.05）,但左心房内径及二尖瓣反流无明显变化.两组间比较,左心房内径在窦性心律组较新发房颤组有明显缩小的趋势（P=0.057）.亚组分析,阵发性房颤患者术后心功能、LVEF较术前改善（P＜0.05）,而持续性房颤患者术后各指标较术前均无明显变化.CRT术后新发房颤危险因素经Logistic回归显示为术前二尖瓣反流程度（P=0.046,OR=3.729）和新发房颤发生前的心房起搏比例（P=0.010,OR=1.050）.结论 CRT术后新发房颤与二尖瓣反流程度加重和心房起搏比例增高明显相关.新发阵发性房颤一般不影响CRT疗效,新发持续性房颤CRT术后疗效较差.

Comparison of the outcome between patients with new-onset atrial fibrillation and patients retained sinus rhythm after cardiac resynchronization therapy

Objective To evaluate the effect of cardiac resynchronization therapy (CRT)in chronic congestive heart failure(CHF) patients who developed new-onset atrial fibrillation(AF) during one year followup after CRT,compared with those patients who retained sinus rhythm (SR). Methods The study population consisted of 54 consecutive patients(42 men and 12 women;age 60. 2 ± 11.4 years)who had an indication for CRT with no history of AF. New-onset AF was defined as atrial high-rate episodes ＞ 180 bpm for more than 10minutes as detected by the device, or as any AF documented on an electrocardiogram or Holter monitoring during follow-up. Patients were assigned to the AF group and to sinus rhythm(SR) group. Clinical and echocardiographic(Echo) evaluation was performed at baseline、 after 6 months and 12 months of biventricular pacing. Results 12(22. 2% )patients developed new-onset AF during one year follow-up. In the SR group,both the clinical and Echo indicators improved significantly after CRT( P ＜ 0. 001 ). And in the AF group, there was also a significant improvement in NYHA functional class and left-ventricular( LV )ejection fraction during oneyear follow-up( P ＜ 0. 001 ), as well as a reduction in LV end-diastolic diameter( P = 0. 017 ) and a raised trend in 6-min walk test( P = 0. 078 ). But there was no changes about the left-atrial(LA) diameter and mitral regurgitation (MR). When compared to the SR group, patients in AF group showed a trend of less LA reverse remodeling( △LA, -0. 1 ±5.3 mm vs. -3. 2 ±5.3 mm,P =0. 057). In logistic regression analysis,MR at baseline (P =0. 046 ,OR =3. 729,95% CI 1.021-13. 613) and the percentage of atrail pacing(AP% ) before AF occurrence were the independent predictors of new-onset AF after CRT( P = 0. 010, OR = 1. 050,95% CI 1. 012-1.089). Conclusion Patients with new-onset persistent AF had unfavorable outcomes after CRT. The severe MR and high AP% were the independent predictors of new-onset AF after CRT.