心房颤动环肺静脉消融术后复发的预测因素

目的探讨心房颤动(简称房颤)环肺静脉消融术(CPVA)后复发的预测因素。方法109例接受CPVA治疗的房颤患者,在三维电解剖标测系统(CARTO)指导下行环绕同侧肺静脉的线性消融,消融终点为肺静脉电隔离(PVI)。通过对10项临床和消融过程指标进行分析,确定单次CPVA术后早期(<3个月)复发和晚期(≥3个月)复发的预测因素。结果所有患者均实现消融终点,其中59例为通过单一CPVA法(简称强化CPVA法)实现PVI,50例为通过CPVA联合肺静脉口节段性消融法(简称改良CPVA法)实现PVI。49例(45.0%)在术后早期复发房性快速心律失常(ATa)。单因素分析显示左房增大、合并器质性心脏病和改良CPVA法是术后早期复发的预测指标;但经多因素分析后仅有改良CPVA是独立的预测指标(P<0.001;RR4.670;95%CI1.996~10.927)。随访9.1±3.5(4~15)个月,33例(30.3%)在术后晚期复发ATa。单因素分析显示左房增大、合并器质性心脏病和改良CPVA同时也是晚期复发的预测指标,但亦仅有改良CPVA是经多因素分析确定的独立预测指标(P=0.036;RR0.391;95%CI0.613~0.941)。严重并发症包括1例心脏压塞和1例脑卒中。结论在以PVI作为房颤CPVA治疗的消融终点时,无论是术后早期复发或晚期复发,改良CPVA法均是其独立的预测因素。     

肺静脉隔离术后心房颤动早期复发和延迟愈合的相关因素分析

目的探讨Lasso标测导管指导下行节段性肺静脉电隔离术后心房颤动(房颤)早期复发和延迟愈合的相关因素。方法120例[男性104例,女性16例;平均年龄(50．4±8．9)岁]行节段性肺静脉电隔离术的房颤患者,单因素和多因素分析老龄(≥60岁)、性别、房颤类型、病史、合并高血压、左心房直径、射血分数、P波离散度、被隔离肺静脉数及手术时间与早期复发和延迟愈合的相关性。结果早期复发率为48．3％(58／120),左心房扩大(P=0．004)和老龄(P=0．033)与早期复发显著相关,左心房直径是早期复发的独立预测因素(OR=1．16,95％CI为1．04～1．28,P=0．005);延迟愈合率为29．3％(17／58),与延迟愈合显著相关的变量为:P波离散度(P<0.001)、左心房直径(P=0．016)、老龄(P=0．001)。P波离散度是延迟愈合的独立预测因素(OR=0．92,95％CI为0．87-0．97,P=0．005)。结论左心房扩大、老龄与肺静脉隔离术后房颤早期复发有关,左心房直径是早期复发的独立预测因素;P波离散度较小、左心房无扩大的低龄患者延迟愈合的可能性较大,P波离散度是延迟愈合的独立预测因素。     

术前血浆大内皮素-1水平对环肺静脉消融后心房颤动复发的预测作用

目的探讨环肺静脉射频消融(CPVA)治疗心房颤动(简称房颤)患者术前血浆大内皮素-1(big ET-1)浓度能否预测术后房颤复发。方法 119例房颤患者接受单一术者进行的单次CPVA手术,其中阵发性房颤75例,持续性房颤44例。房颤复发定义为随访期内心电图和/或24h动态心电图证实房颤发作持续时间≥30s。术前血浆big ET-1浓度测定应用酶联免疫吸附分析法测定。结果在28±12个月的随访中,CPVA术后房颤复发率为30.3%(36/119),其中阵发性房颤为25.3%(19/75),持续性房颤为38.6%(17/44)。房颤复发患者术前血浆bigET-1浓度升高明显(1.29±0.77fmol/ml vs 0.66±0.49fmol/ml,P<0.001),无论是阵发性房颤(1.30±0.69fmol/ml vs 0.61±0.40fmol/ml,P=0.001),还是持续性房颤(1.29±0.87fmol/ml vs 0.78±0.63fmol/ml,P=0.007)均升高。多因素Logistic回归分析显示:血浆bigET-1与消融后房颤复发有关,能独立预测房颤复发(P<0.001)。亚组分析显示:阵发性房颤患者血浆bigET-1浓度升高与消融后房颤复发有关(P=0.001);持续性房颤患者血浆bigET-1浓度升高不能预测CPVA术后房颤的复发。结论 CPVA术前血浆bigET-1水平升高可能是阵发性房颤术后房颤复发的预测因素。     

高敏C反应蛋白能预测环肺静脉射频消融治疗后的心房颤动复发

目的探讨环肺静脉射频消融（CPVA）治疗心房颤动（房颤）患者消融术前血浆高敏C反应蛋白（hsCRP）浓度能否预测术后房颤复发。方法121例房颤患者接受单一术者进行的单次CPVA术,其中阵发性房颤77例,持续性房颤44例。房颤复发定义为随访期内心电图和／或24h动态心电图证实房颤发作持续时间≥30s。应用酶联免疫法测定血浆hsCRP浓度。结果在5～44（28±12）个月的随访中,单次CPVA术后房颤复发率为29．75％（36／121）,其中阵发性房颤为24．68％（19／77）,持续性房颤为38．6％（17／44）。房颤复发患者无论是阵发性房颤[（2．16±1．51）mg／L对（1．27±1．19）mg／L,P=0．028],还是持续性房颤[（2．59±1．52）mg／L对（1．45±1．32）mg／L,P=0．005],消融术前血浆hsCRP浓度均较高[（2．36±1．51）mg／L对（1．33±1．23）mg／L,P〈0．001]。多因素Logistic回归分析显示,血浆hsCRP浓度升高与消融术后房颤复发有关,能独立预测房颤复发（P〈0．001）。结论CPVA术前血浆hsCRP浓度升高与术后房颤复发有关,可能是术后房颤复发的独立预测因素。     

P波离散度对房颤消融术后预后的影响

目的探讨P波离散度(Pd)对阵发房颤环肺静脉消融(CPVA)术远期预后的预测价值。方法顺序入选116例阵发性房颤患者行CPVA术至肺静脉电隔离。测量和计算算末次消融术前和术后P波最大值(Pmax),P波最小值(Pmin),P波离散度(Pd)。结果随访45.7±19.2个月,112例患者完成了研究,成功率达78.6%。根据随访结果,分为成功组和复发组。两组消融术前Pmax、Pmin和Pmax相似。成功组术后Pmax和Pd显著降低[Pmax(101.2±10.9)vs(.117.3±13.8)ms,p<0.01;Pd(34.8±6.7)vs.(49.3±10.3)ms,p<0.01],而复发组术后P波各参数均无明显变化。两组相比,成功组术后Pd和Pmax较复发组显著降低[Pmax(116.4±9.9)ms,Pd(49.2±8.8)ms]。COX回归分析显示两组左房内径和LVEF均无明显差异;术后Pd和Pmax是阵发房颤CPVA术后远期复发的独立预测因子。结论 Pmax和Pd反映了心房非均质性活动,术后Pmax和Pd可作为阵发房颤CPVA术后远期复发的预测因素。     

心房颤动射频消融术后晚期复发的相关因素

目的:分析心房颤动（房颤）经导管射频消融术后晚期复发的相关因素。方法:房颤患者117例接受经导管射频消融术治疗,术前进行常规检查评估,在CARTO三维标测系统指导下行左房环肺静脉消融,必要时加行左房线性消融、右房线性消融等策略。如果在消融结束后心电监护仍为房颤心律,则行体外电复律。通过术后随访（>3个月）确定房颤消融术后是否复发,收集相关的随访资料分析房颤术后晚期复发的预测因素。结果:①所有患者均完成环肺静脉隔离。58例患者在环肺静脉消融基础上加行左房线性消融、右房线性消融等方法。37例房颤患者在消融后房颤仍持续,经体外电转复均恢复窦律。32例(27.3%)患者在术后晚期复发。②单因素分析显示性别、并发器质性心脏病、房颤病程、持续性房颤、左房内径、左室射血分数和复律与术后房颤晚期复发相关（均P<0.05）。③经多因素分析后仅有性别、左房内径、房颤病程是房颤晚期复发的独立预测指标(分别P<0.05,P<0.05,P<0.01)。结论:性别、房颤病程、左房内径是房颤导管消融术后晚期复发的独立预测因素。     

心房纤颤患者射频消融术后复发的相关因素分析

目的探讨心房纤颤(房颤)经导管射频消融术后与复发相关的预测因素及可能机制。方法收集2015年1月~2015年5月,天津医科大学总医院行射频消融术的房颤患者105例。根据术后复发与否,分为复发组(n=24)、无复发组(n=81),比较两组间临床资料差异。采用多因素Logistic回归分析筛选影响房颤患者射频消融术后复发的独立预测因素。结果两组患者间比较,性别、年龄、房颤病史、体质指数(BMI)、器质性心脏病、高血压、糖尿病、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)水平无统计学差异(P0.05)。房颤类型、左房前后径(LA)、术中电复律、术后早期复发,两组间有统计学差异(P0.05),纳入多因素logistic回归分析,提示术后早期复发是房颤消融术后复发的独立预测因素(OR=5.236,95%CI:1.747~15.690,P0.01)。术后空白期内房性心律失常发作多出现在术后1月内,且1月后仍有发作者,房颤晚期复发的风险明显增加。结论房颤术后早期复发(空白期内)是房颤消融术后复发的独立预测因素,且消融后1月后仍有发作的患者,房颤晚期复发的风险明显增加。     

心房颤动射频消融术后复发的相关危险因素研究

目的 分析心房颤动（房颤）导管射频消融术后复发患者的临床特点,探讨影响房颤患者术后复发的危险因素.方法 回顾性分析2008年2月至2012年2月在南方医科大学南方医院进行射频消融治疗的房颤复发患者124例的临床病历资料,将上述信息作为房颤患者术后复发的预测因素.采用x2检验和t检验进行单因素分析,在此基础上进一步采用多因素Logistic回归分析筛选影响房颤患者射频消融术后复发的独立危险因素.结果 本研究共纳入113例患者,射频消融术后随访时间（15.37＆#177;6.21）个月.33例（29.20％）患者出现早期复发,37例（32.74％）患者出现晚期复发.多因素Logistic回归分析显示,左心房直径变大（OR=1.190,95％CI：1.028～1.378,P=0.020）、体质量指数越大（OR=1.109,95％CI：1.001～1.212,P=O.009）、伴发睡眠呼吸暂停综合征（OR=1.239,95％CI：1.079～1.423,P=0.002）是房颤患者消融术后早期复发的危险因素;消融术中采用电复律（OR=1.937,95％CI：1.314～2.856,P=0.001）是晚期复发的危险因素.结论 房颤消融术后复发率较高,左心房内径、体质量指数、睡眠呼吸暂停综合征、术中电复律是患者术后复发的独立危险因素,加强术后患者的定期随访具有重要的临床价值.     

心房颤动导管消融术后极晚期复发及其相关因素的研究

目的研究房颤导管消融术后极晚期复发患者的临床特点及极晚期复发的临床预测因素。方法对心房颤动导管消融治疗后的复发患者进行回顾性研究,分析其临床特征并总结出极晚期复发的临床预测因素。结果共计235例患者入选该研究,射频消融后平均随访(18.2±4.6)个月,12例(5.1%)患者出现极晚期复发。极晚期复发、晚期复发与无复发3组患者组间比较显示,持续性房颤、术中电复律比例、完全肺静脉隔离率以及早期复发发生率在3组间差异具有统计学意义。Logistic单因素分析显示,早期复发(OR9.223,95%CI2.087～30.409;P=0.002)、持续性房颤(OR4.799,95%CI1.152～12.777;P=0.028)与极晚期复发相关。Logistic多元回归分析显示,早期复发是极晚期复发的惟一临床预测指标(OR=7.798,95%CI1.893～38.249;P=0.005)。结论心房颤动射频消融术后极晚期复发并不常见,其发生与消融后早期复发相关。     

单核细胞与高密度脂蛋白胆固醇比值对射频消融术后晚期心房颤动复发的预测价值

目的探讨单核细胞/HDL-C比值(MHR)对老年阵发性心房颤动(房颤)患者射频消融术后晚期复发的预测价值。方法纳入江苏省苏北人民医院行导管射频消融术的老年阵发性房颤患者82例,根据消融术3个月后房颤是否复发分为复发组31例和未复发组51例,收集入选患者术前临床资料,采用logistic回归分析术后复发的影响因素。结果老年阵发性房颤行射频消融术患者术后晚期复发率为37.8%,复发组房颤病程、单核细胞、MHR及左心房内径明显高于未复发组,HDL-C明显低于未复发组,差异有统计学意义(P0.05,P0.01)。logistic回归分析显示,校正相关因素后,左心房内径和MHR是阵发性房颤射频消融术后晚期复发的独立危险因素(OR=1.280,95%CI:1.079～1.518,P=0.005;OR=1.482,95%CI:1.153～1.906,P=0.002)。ROC曲线分析显示,MHR预测阵发性房颤射频消融术后晚期复发的曲线下面积为0.76(95%CI:0.650～0.870,P=0.000)。结论 MHR是老年阵发性房颤患者射频消融术后晚期复发的独立预测因素。     

Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation.

AIMS: The success rate of circumferential pulmonary vein ablation (CPVA) to treat atrial fibrillation (AF) ranges from 60 to 90%, depending on the series. The objective of the study was to identify predictors of AF recurrence after a standardized CPVA procedure. METHODS AND RESULTS: A series of 148 consecutive patients undergoing CPVA for symptomatic paroxysmal (60.8%), persistent (23.6%), or permanent (15.5%) AF refractory to antiarrhythmic drugs were included in the study. CPVA with the creation of supplementary block lines along the posterior wall and mitral isthmus was performed and a minimum of 6 months follow-up completed in all patients. Structural heart disease was present in 19.6% and hypertension in 33.8% of patients. After 13.1 +/- 8.4 months follow-up, 73.6% of patients were free of AF recurrences after a mean of 1.18 +/- 0.45 procedures/patient (one procedure in 85.2%, two procedures in 14.8%, and three procedures in 2.7%). Univariable analysis showed that the risk of AF recurrence increases with age (HR 1.03; 95% CI 1.00-1.06, P = 0.031), with the presence of previous hypertension (HR 2.7; 95% CI 1.43-5.07, P = 0.002), and if AF is permanent (HR 2.23; 95% CI 1.08-4.59, P = 0.042). In addition, larger anteroposterior left atrial diameter (LAD) (HR 1.11; 95% CI 1.05-1.18, P = 0.001) and larger left ventricular end-systolic diameter (HR 1.07; 95% CI 1.00-1.15, P = 0.029) prior to the procedure were associated with AF recurrence after CPVA. Cox regression analysis showed that hypertension (OR = 2.8; 95% CI 1.5-5.4; P = 0.002) and LAD (OR = 1.1; 95% CI 1.05-1.19, P < 0.001) were independent predictors of AF recurrence. The mean predicted proportion of patients with AF recurrence after CPVA of the multivariable model showed a linear relationship with the increase in LAD prior to the procedure. The presence of hypertension further increased the mean predicted proportion of patients with AF recurrence at each LAD. CONCLUSION: Hypertension and LAD are independent pre-procedural predictors of AF recurrence after CPVA to treat AF. These data may help in patient selection for AF ablation.     

Predictors of very late recurrence of atrial fibrillation after circumferential pulmonary vein ablation

BACKGROUND: Early recurrence of atrial fibrillation (ERAF) after catheter ablation is common and has been thoroughly studied. However, very late recurrence of atrial fibrillation (VLRAF) is rarely researched, and its characteristics have not been determined. HYPOTHESIS: The aim of this study was to investigate the clinical characteristics of VLRAF after circumferential pulmonary vein ablation (CPVA), and to identify the risk factors for VLRAF. METHODS: We retrospectively studied 259 consecutive patients with atrial fibrillation (AF) who were referred for CPVA. Clinical variables were investigated and predictors of VLRAF were identified. RESULTS: A total of 249 patients were enrolled in this study. After a mean follow-up of 18.2 +/- 4.4 mo, 14 patients (5.6%) had VLRAF. Patients with VLRAF were more likely than those without recurrence to have ERAF (78.6% versus 17.8%, p = 0.000) and persistent AF (50.0% versus 13.0%, p = 0.000), but were less likely to achieve pulmonary vein (PV) isolation (78.6% versus 97.6%, p = 0.000). Bivariate analysis demonstrated that ERAF (odds ratio [OR] 8.148, 95% confidence interval [CI] 2.197-30.222; p = 0.002), persistent AF (OR 8.853, 95% CI 1.773-16.155; p = 0.003), and lack of PV isolation (OR 7.530, 95% CI 1.792-33.122; p = 0.006) were related to VLRAF. Multivariate logistic regression analysis only identified ERAF as a predictor of VLRAF after CPVA (OR 7.461, 95% CI 1.696-24.836; p = 0.006). CONCLUSIONS: Very late recurrence of AF is uncommon after CPVA. That occurs more commonly in patients with ERAF.     

心房颤动导管消融术后电复律即刻成功预测因素分析

目的:对影响心房颤动导管消融术后3个月内复发患者直流电复律成功率的因素进行回顾性研究。方法:连续入选2010年11月至2011年11月,在北京安贞医院心内科二病房行持续性心房颤动导管消融术,且在术后3个月内因持续性房性心律失常住院行电复律的患者。禁食状态下,地西泮静脉注射镇静,行双向同步直流电复律,除颤电极片置于心尖区及胸骨旁右侧,能量依次采用50～200J。结果:共入选63例患者,年龄33～69岁,平均心房颤动病史14.6个月,左心房直径(42.8±5.2)mm,左心室射血分数(62.9±5.3)%。复发持续性心律失常中46%为心房扑动,54%为心房颤动,共进行97次电复律。患者即刻复律成功率为77%,其中80%一次放电复律成功。在年龄、性别、合并疾病、左心室射血分数、术前是否服用心律平等方面,即刻复律成功组与即刻失败组相比,两组间差异无统计学意义(P>0.05)。单因素分析示年龄、左心房扩大心房颤动持续时间与电复律即刻成功率显著相关。进行Logistic回归分析校正上述因素后发现,术前心房颤动持续时间(OR=0.957,95%CI:0.921～0.994,P=0.023)和术前服用胺碘酮是复律成功率的独立预测因素。即刻成功的定义是复律后维持窦性心律>24 h。结论:心房颤动导管消融术后早期复发的患者,术前心房颤动持续时间和术前服用胺碘酮是电复律即刻成功的独立预测因素。     

已达到消融终点的长程持续性心房颤动复发危险因素分析

目的：探讨已达到消融终点的长程持续性心房颤动（房颤）患者复发的危险因素。方法：纳入达到消融终点的长程持续性房颤患者256例,消融终点定义为双侧肺静脉电隔离,二尖瓣峡部和左心房顶部线性消融双向阻断且碎裂电位消失。根据随访结果将患者分为房颤复发组（n＝43）和无复发组（n＝213）。通过多因素 COX 回归分析探讨房颤复发的独立危险因素。结果：经过（19．5±3．6）个月随访,与无复发组相比,房颤复发组患者右心房内径较大,为（53．31±6．55）mm 对（48．74±5．87）mm;房颤持续时间较长,为（81．83±45．75）个月对（53．16±40．23）个月;左心房内径较大,为（49．85±6．82）mm 对（46．77±5．83）mm,P 均＜0．01。多因素 COX 回归分析发现,左心房内径增大（OR＝1．01,95％CI：1．01～1．28,P ＜0．05）,右心房内径增大（OR＝2．85,95％CI：1．15～7．03,P ＜0．05）、房颤持续时间延长（OR＝1．01,95％CI：1．01～1．02,P ＜0．05）是房颤复发的独立危险因素。结论：除左心房内径和房颤持续时间外,右心房内径增大也是已达到消融终点的长程持续性房颤复发的独立危险因素。     

Long-term efficacy of delayed cure after circumferential pulmonary vein ablation of atrial fibrillation

INTRODUCTION: The reliability of delayed cure of early recurrence of atrial fibrillation (ERAF) is still undetermined. Furthermore, the predictors of recurrence after delayed cure of ERAF are less investigated in depth. AIMS OF THE STUDY: The purpose of this study was to investigate the long-term efficacy of delayed cure of ERAF after catheter ablation of AF and explore the he predictors of recurrence after delayed cure of ERAF. METHODS AND RESULTS: We prospectively studied 300 consecutive patients with atrial fibrillation (AF) who were referred for circumferential pulmonary vein ablation (CPVA). After a follow-up of 19.2 +/- 4.1months, of the 87 patients with early recurrence of AF 41 achieved delayed cure, 11 of them reoccurred AF subsequently. Univariate analysis showed that persistent AF, absence of pulmonary vein (PV) isolation and external cardioversion were related to reoccurrence after delayed cure. Logistic regression analysis identified only absence of PV isolation as a predictor of recurrent AF after delayed cure. CONCLUSIONS: Delayed cure after CPVA is relatively common and its efficacy at long-term follow-up is reasonably consistent. However, in patients without PV isolation, delayed cure is unstable and the risk of late recurrence is increased.     

Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: a randomized comparison between two different isolation approaches

Introduction: Circumferential pulmonary vein ablation (CPVA) with the endpoint of pulmonary vein (PV) isolation has been developed as an effective therapy for atrial fibrillation (AF). This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first-time CPVA procedure.
Methods and Results: One hundred consecutive patients (69 male; age, 56.7 ± 11.6 years) who underwent first-time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A-CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M-CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M-CPVA group and in only 15 patients (30%) in the A-CPVA group (P < 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M-CPVA group, compared with 9 patients (18%) in the A-CPVA group (P = 0.01). At 13 ± 4 months, patients treated by the A-CPVA approach had greater freedom from ATa recurrence than patients who underwent M-CPVA (P = 0.01). The M-CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123–0.821; P = 0.02).
Conclusions: When PV isolation is the endpoint of CPVA, the efficacy of the A-CPVA approach is better than that of M-CPVA.