环肺静脉前庭隔离术终止持续性心房颤动的临床预测因素

目的探讨持续性心房颤动(简称房颤)经环肺静脉前庭隔离术(CPVAI)术中终止的临床预测因素。方法 85例在三维电解剖标测系统(CARTO)指导下首次接受CPVAI治疗的持续性房颤患者。消融在房颤心律下进行,终点为肺静脉前庭电隔离。对术中房颤经消融终止及未终止者20项临床指标进行分析,确立对术中房颤经消融终止具有预测价值的指标。结果所有患者均实现消融终点。术中房颤经消融终止者28例(32.9%),其中12例直接恢复为窦性心律,16例转为房性心动过速,57例CPVAI后仍为房颤。单因素分析结果显示:房颤持续时间、既往有阵发性房颤病史、短病程(1年)持续性房颤、阵发性房颤病史+短病程持续性房颤是预测术中房颤经消融终止的指标,但经多因素分析后仅有阵发性房颤病史+短病程持续性房颤是预测术中房颤经消融终止的指标(P0.001;RR∶0.100;95%C I∶0.033~0.307)。结论由阵发性房颤进展而来的短病程持续性房颤是CPVAI术中房颤经消融终止的独立预测指标。

Clinical predictors of procedural arrhythmia termination during circumferential pulmonary vein antrum isolation in patients with persistent atrial fibrillation

Objective To investigate the clinical predictors of termination of persistent atrial fibrillation （AF） by abla- tion during circumferential pulmonary vein antrum isolation （CPVAI） procedures. Methods Eighty-five consecutive pa- tients with persistent AF who underwent initial CPVAI guided by 3-dimentional electroanatomic mapping system （CARTO） were included. The ablation procedure was performed under AF with an endpeint of pulmonary vein antrum isolation （PVAI）. Univariate analysis and multivariate analysis were carried out to assess the predictive value of 20 clinical variables on the AF termination by ablation. Results All patients achieved the ablation endpoint successfully. Of 85 patients, AF was terminated by ablation in 28 （32.9%）, including AF converted to sinus rhythm directly in 12 and organized to atrial tachycardias in 16. By univariate analysis, the duration of continuous AF, short lasting （less than I year） persistent AF, with paroxysmal AF history, and short lasting persistent AF combined with paroxysmal AF history were predictors of proce- dural termination of AF. However, only short lasting persistent AF combined with paroxysmal AF history was the independ- ent predictor （P〈0. 001;RR：0. 100;95%CI：0.033 -0.307）by multivariate analysis. Conclusion Short-lasting persistent AF which progressed from paroxysmal AF is much easier to be terminated by ablation during CPVAI procedures.