安装心脏植入型电子装置的肥厚型心肌病患者合并严重房室阻滞的影响因素分析

目的:探索安装心脏植入型电子装置的肥厚型心肌病(HCM)患者发生严重房室阻滞(AVB)的影响因素。方法:连续收集2002年11月至2013年6月在我院心律失常中心安装心脏植入型电子装置且出院诊断为HCM的患者126例,男性71例,女性55例,平均年龄(57.02±14.93)岁。根据是否有高度及以上AVB,将患者分为严重AVB组(28例)和非严重AVB组(98例)。比较两组患者一般临床资料、血清学检查、心电图及超声心动图指标,应用二分类Logistic回归分析探讨HCM患者发生严重AVB的影响因素。结果:126例患者中,103例植入起搏器,22例安装埋藏式心脏复律除颤器(ICD),1例进行心脏再同步化治疗(CRT)。非严重AVB组患者年龄(58.0±13.2)岁,女性45例(45.9%);严重AVB患者年龄(53.5±19.8)岁,女性10例(35.7%)。非严重AVB组与严重AVB组比较,心房颤动比例、静息左心室流出道压差峰值、β受体阻滞剂及钙拮抗剂使用率显著升高,而糖尿病比例显著降低、QRS时限明显缩短(P均<0.05)。二分类Logistic回归分析示糖尿病(OR=5.023,95%CI:1.452~17.382,P=0.011)是HCM患者发生严重AVB的影响因素。结论:在安装心脏植入型电子装置的HCM患者中,糖尿病是发生严重AVB的显著影响因素。

Influence Factors of Severe Atrioventricular Block in Patients With Hypertrophic Cardiomyopathy Undergoing Cardiac Device Implantation

Objectives:To investigate the influence factors in patients with hypertrophic cardiomyopathy(HCM)accompanied by severe atrioventricular block(AVB).Methods:A total of 126 patients who were discharged from the cardiac arrhythmia center of our hospital following the cardiac implantable electronic device implantation and diagnosed with HCM from November 2002 to June 2013 were continuously enrolled.According to the absence or presence of advanced/complete AVB or AVB,patients were divided into the non-severe AVB group(n=98)and the severe AVB group(n=28).General clinical data,serological examination,electrocardiographic and echocardiographic parameters of the two groups were compared,and binary logistic regression analysis was used to explore the influence factors of severe AVB.Results:Of the 126 patients,103 received pacemaker implantation,22 received implantable cardiac defibrillator(ICD),and 1 underwent cardiac resynchronization therapy(CRT).The mean age of HCM patients without severe AVB was(58.8±13.2)years old,with 45 women(45.9%).The mean age of HCM patients with severe AVB was(53.5±19.8)years old,with 10 women(35.7%).Prevalence of atrial fibrillation,left ventricular outflow tract gradient,and proportion ofβ-receptor blocker and calcium channel blocker use were significantly higher in the non-severe AVB group than in the severe AVB group(all P<0.05),while the rate of diabetes mellitus and QRS duration were significantly lower in the non-severe AVB group than in the severe AVB group(P<0.05).Binary logistic regression analysis showed that the diabetes mellitus(OR=5.023,95%CI:1.452-17.382,P=0.011)was an influence factor of severe AVB in patients with HCM.Conclusions:Diabetes mellitus is a significant influence factor of severe AVB in HCM patients with cardiac implantable electronic device.