超重和肥胖对心房颤动导管消融复发的影响

目的探讨超重和肥胖对心房颤动(简称房颤)导管消融复发的影响。方法回顾性分析连续入院在三维标测系统指导下行环肺静脉线性消融的患者369例,复发定义为消融1个月后发生持续30s以上的房性快速性心律失常,以体重指数≥25.0kg/m2做为超重和肥胖的诊断标准。结果369例中超重和肥胖199例,左房前后径和左室舒张末径在超重和肥胖组显著大于非超重和肥胖组(40.2±6.0mmvs36.6±6.5mm,P<0.001;49.1±7.1mmvs46.9±6.6mm,P=0.003)。随访459±181天,超重和肥胖组复发率为40.2%,非超重和肥胖组的复发率为25.9%,两组间差异有显著性(P=0.004)。单因素分析发现超重和肥胖、持续性/永久性房颤、左房前后径、左室舒张末径是导管消融复发的预测因素。经校正房颤病程、房颤类型、高血压、器质性心脏病,Cox多因素分析显示超重和肥胖是房颤复发的独立危险因素(危险比=1.67,95%可信区间1.13～2.46,P=0.009)。进一步校正左房前后径和左室舒张末径,Cox多因素分析发现只有左房前后径是复发的独立预测因素(危险比=1.04,95%可信区间1.01～1.08,P=0.010)。结论超重和肥胖是影响房颤导管消融复发的重要因素,其机制可能是通过左房增大介导的。

Impact of overweight and obesity on recurrence of atrial fibrillation after catheter ablation

Objective To investigate the impact of overweight and obesity on recurrence of atrial fibrillation （AF） after catheter ablation. Methods From January 2005 to July 2006, consecutive patients with AF who underwent circumferential pulmonary vein ablation guided by 3-D mapping system were enrolled in the retrospective study. The recurrence was defined as atrial tachyarrhythmia lasting more than 30 seconds beyond one month washout period. Overweight and obesity was diagnosed by body mass index ≥25.0 kg/m2. Results Among the 369 patients, 199 patients had overweight and obesity （53.9%）. The left atrium size and left ventricular end-diastolic diameter were siguifieandy larger in the overweight and obese arm than in the other arm （40.2 ±6.0 mm vs 36.6 ±6.5 mm,P 〈0.001 ; 49.1 ±7.1 mm vs 46.9 ±6.6 mm,P = 0.003, respectively）. After mean 459 ± 181 days follow-up, the incidence of recurrence was significantly higher in the o- verweight and obese arm （40.2% vs 25.9% , P = 0.004）. Univariate analysis showed overweight and obesity, non-paroxysmal AF,left atrium size and left ventricular end-diastolic diameter were predictors of the recurrence. Adjusted for AF duration, non-paroxysmal AF, hypertension and structural heart disease, Cox regression analysis revealed that overweight and obesity was an independent predictor of recurrence （ Hazard ratio 1.67, 95% Confidence Interval 1.13 - 2.46, P = 0. 009 ）. Further adjusted for left atrium size and left ventrieular end-diastolic diameter, only the left atrium size was an independent predictor of the recurrence （ Hazard ratio 1.04, 95% Confidence Interval 1.01 - 1.08, P = 0.010 ）. Conclusion Overweight and obesity have great impact on the recurrence of AF after catheter ablation, it is probably mediated by left atrium size.