自身免疫性疾病合并心房颤动导管消融的疗效

目的探讨自身免疫性疾病（免疫病）对心房颤动（简称房颤）导管消融的影响。方法回顾性分析本院在三维标测系统指导下行射频消融的房颤合并激素和免疫抑制剂治疗稳定后的免疫病患者共15例（免疫病组）,并按照1∶4比例匹配了60例房颤类型、性别、年龄（±2年）、手术时间（±1年）的非免疫病房颤患者（非免疫病组）。比较两组包括C反应蛋白在内的临床特征及房颤导管消融的疗效复发情况。复发定义为消融术后发生持续30 s以上的房性快速性心律失常。结果免疫病组C反应蛋白显著高于非免疫病组（6.14±9.50 mg/dl vs 1.81±2.35 mg/dl,P=0.001 8）,其它临床指标两组无差异。随访462±416天,两组房颤复发率无差异33.33%（5/15）vs35%（21/60）,P〉0.05]。免疫病组5例均在81天内复发（中位数18 vs 92 d,P=0.037 3）。免疫病组临床症状改善明显（66.7%,10/15）。结论经激素和免疫抑制剂等治疗稳定后,免疫病合并房颤患者行导管消融术是安全、有效的。术后早期房颤复发率高。

The efficacy of catheter ablation on atrial fibrillation with autoimmune rheumatic diseases

Objective To investigate the efficacy of radiofrequency catheter ablation on atrial fibrillation（ AF） with autoimmune rheumatic diseases（ ARDs）. Methods From April 2008 to September 2012,consecutive patients with AF who underwent radiofrequency catheter ablation guided by 3-D mapping system were retrospectively enrolled. ARDs were diagnosed according to the guidelines. For controls,we selected 60 AF patients without ARD who underwent catheter ablation with similar sex-,age-,and operation time（ 4 controls for each ARDs patient）. Recurrence was defined as atrial tachyarrythmia lasting more than 30 seconds. Result Patients with ARDs had significantly higher CRP（ 6. 14 ± 9. 50 mg / dl vs 1. 81 ± 2. 35 mg / dl,P = 0. 0018）. During a mean follow-up of 462 ± 416 days,the AF recurrence rate in ARDs group（ 33. 3%,5/15） was similar to that of control group（ 35%,21/60; P 0. 05）. All recurrent patients with ARDs had early recurrence within 83 days（ Median 18 vs 92 days,P = 0. 0373）. Main symptoms of ARD patients after ablation had improved（ 66. 7%,10 /15）. Conclusion Catheter ablation could be safely performed in AF with ARDs patients,which have a comparable success rate to those without ARDs.