QT延长与高血压合并心房颤动导管射频消融术后复发的相关性分析

目的 探讨高血压合并阵发性心房颤动患者的QTc是否与心房颤动导管射频消融术后复发相关.方法 回顾性分析201 1年1月至2012年12月在北京安贞医院第1次行导管射频消融术的高血压合并阵发性心房颤动心功能正常患者242例,将纳入患者按疾病复发情况分为复发组（98例）和未复发组（144例）,收集术前心电图和其他临床资料,术后定期随访.结果 随访（17±9）个月,98例患者（40.0％）心房颤动导管消融术后复发.与未复发组相比,复发组QTc明显延长（429±26） ms比（419 ±23） ms]（P=0.004）.复发组的左心房前后径较未复发组明显增大（41±6）mm比（38±5）mm]（P=0.003）.QTc与心率存在明显的相关性（r=0.162,P=0.011）.长QTc组（n=53）的导管消融术后心房颤动复发率明显较正常QTc组（n=165）和短QTC组（n=24）高（P =0.001、P=0.069）;左心房直径＜38.3 mm组与左心房直径≥38.3 mm组消融术后心房颤动复发率比较,左心房增大与导管消融术后复发相关（P=0.017）.多因素Cox回归分析表明QTc和左心房前后径是心房颤动复发的独立危险因素（QTc：风险比=2.361,95％置信区间：1.353 ～4.121,P=0.003;左心房前后径：风险比=1.795,95％置信区间：1.041 ～3.094,P=0.035）.长QT患者心房颤动复发的风险比为2.361（95％置信区间：1.353 ～4.121,P=0.003）.与左心房前后径单独预测术后复发相比,左心房前后径和QTc联合能更好地预测心房颤动导管消融术后复发.结论 QT延长是高血压合并心房颤动导管消融复发的独立危险因素.

Correlation analysis on QT prolongation and hypertension combined with atrial fibrillation after radiofrequency catheter ablation

Objective To determine whether prolongation of QTc interval predicts atrial fibrillation （AF） recurrence after catheter ablation in a cohort of patients with hypertension.Methods We retrospectively enrolled 242 hypertensive patients with AF who underwent the first time catheter ablation procedure in Beijing Anzhen hospital,all patients were divided into relapse group （98 cases） and no relapse group （144 cases） according to disease relapse.Baseline data and QTc before procedure were collected.Results 98 patients had AF recurrence after a mean follow-up of （17 ± 9） months.Those experiencing recurrence had longer QTc than those who did not experience recurrence（419 ±23）ms vs （429 ±26） ms] （P =0.004）.Left atrial diameter（LAD） of relapse group was larger than that of no relapse group （41 ± 6） mm vs （38 ± 5）mm] （P =0.003）.There were significant correlation between QTc and heart rate （r =0.162,P =0.011）.Recurrence of AF after catheter ablation of long QTc group（n =53） were higher than that of normal QTc group （n =165） and short QTc group （n =24） （P =0.001,P =0.069）.Compare on recurrence of AF after catheter ablation between the group with LAD ＜ 38.3 mm and the group with LAD ≥38.3 mm,left atrial enlargement was associated with recurrence after catheter ablation （P =0.017）.Multivariate Cox regression analysis demonstrated that QTc and LAD were independent predictors for recurrence of AF QTc：hazard ratio（HR） =2.361,95％ CI：l.353-4.121,P =0.003 ;LAD：HR =1.795,95％ CI：I.041-3.094,P =0.035].The patients with longer QTc was associated with an increased risk of AF recurrence （HR：2.361,95％ CI：1.353-4.121,P =0.003）.QTc had an incremental value over LAD in predicting AF recurrence after catheter ablation.Conclusion QT prolongation is an independent risk factor for AF recurrence after catheter ablation in patients with hypertension.