自主神经功能障碍对阵发性房颤射频导管消融术后复发影响的直立倾斜试验预测分析

目的 通过直立倾斜试验(HUTT)探究自主神经功能障碍对阵发性房颤(PAF)患者射频导管消融术后房颤复发的独立预测价值.方法 连续纳入2016-01—2019-12在河南省人民医院心内科首次成功完成环肺静脉射频消融术治疗的阵发性房颤患者208例.所有患者术前行HUTT,根据试验结果分为阳性组(67例)及阴性组(141例...

HUTT predictive analysis of the influence of autonomic dysfunction on the recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation

Objective To investigate the independent predictive value of autonomic dysfunction for paroxysmal atrial fibrillation(PAF)recurrence after radiofrequency catheter ablation(RFCA)by performing the head-up tilt test(HUTT).Methods A total of 208 consecutive patients with PAF from the Department of Cardiology,Henan Provincial People’s Hospital hospitalized for circumferential pulmonary vein radiofrequency ablation between January 2016 and December 2019 were prospectively enrolled in the syudy.All patients were preoperatively subjected to HUTT and divided into HUTT positive group(67 cases)and HUTT negative group(141 cases).All patients were followed up with a 12-lead electrocardiogram and 24-hour Holter recordings before discharge and at 1,3,6,9,and 12 months after the ablative procedure.Additionally,telephone interviews or outpatient services were conducted monthly in all patients by a physician after the operation to find out whether atrial fibrillation has recurred.If patients reported palpitations,an additional electrocardiogram and 24-hour Holter was obtained.Similarly,these patients were divided into atrial fibrillation recurrence group(73 cases)and recurrence-free group(135 cases)based on the postoperative Holter results,symptoms and ECG.Multivariate Cox regression analysis was used to assess the independent predicted effect of HUTT on atrial fibrillation recurrence after catheter ablation,adjusted for other variables.Results HUTT positive was significantly higher in PAF patients with recurrence compared to those without(47.9%vs 23.7%,P<0.001).Multivariate Cox regression analysis revealed that HUTT positive(HR:0.433,95%CI:0.240-0.783,P=0.006),sleep apnea(HR:1.966,95%CI:1.025-3.770,P=0.042),left atrial diameter(HR:1.068,95%CI:1.018-1.121,P=0.007)and AF duration(HR:1.327,95%CI:1.188-1.483,P<0.001)were independent predictors of clinical recurrence after RFCA for PAF.The success rate of ablation was 73.0%in patients in the HUTT negative group compared with 47.8%in patients in the HUTT positive group(Log-Rank P<0.001).Conclusion Patients with a positive head-up tilt test were at an increased risk of atrial fibrillation recurrence after catheter ablation.Our results suggest that HUTT was a significant predictor for atrial fibrillation recurrence after catheter ablation for PAF,suggesting that autonomic dysfunction may increase the risk of clinical recurrence after circumferential pulmonary vein radiofrequency ablation for PAF patients.