典型心房扑动射频消融术后发生心房颤动患者的心房电生理特性

分析典型心房扑动(简称房扑)射频消融术后发生心房颤动(简称房颤)患者的心房电生理特性,探讨心房内传导时间在房颤发生中的意义。56例典型房扑患者,其中19例有器质性心脏病,16例在消融前有房颤发作。所有患者均进行常规的电生理检查及标测,记录消融前后心房的电生理参数。根据消融术后随访是否有房颤的发生分为两组进行分析。结果:56例房扑患者全部消融成功,随访14±12(6～60)个月,中位数14个月。消融术后15例有房颤发作,其中3例进展为慢性房颤。15例有房颤发作患者的年龄较无房颤发作的患者大(57.1±13.6岁vs42.3±11.2岁,P<0.05),消融术前和术后的高右房至冠状窦的传导时间延长(分别为98.4±17.1msvs67.8±16.5ms;93.1±18.4msvs70.2±19.7ms;P均<0.05)。多因素Cox回归分析消融前有房颤发作的病史(危险比2.3,95%CI1.425～4.632,P=0.02)和窦性心律下高右房至冠状窦的传导时间超过90ms(危险比1.7,95%CI1.215～3.758,P=0.03)是预测射频消融术后发生房颤的独立的危险因素。结论:典型房扑射频消融术后发生房颤患者心房内传导延迟,并且房内传导延迟是预测射频消融术后发生房颤的重要电生理指标。

Electrophysiological Properties of Atrium in Patients With Occurrence of Atrial Fibrillation After Flutter Ablation

To analysis electrophysiological properties of atrium in patients with occurrence of atrial fibrillation (AF) after flutter ablation, the significance of intra-atrial conduction time was assessed in patients with occurrence of AF.Programmable electrophysiological examinations and mappings were regularly taken in 56 patients with typical atrial flutter including 19 patients who had structural heart disease and 16 patients who had AF before the procedure, and the electrophysiological parameters of atrium were recorded before and after atrial flutter ablation. These patients were divided into two groups based on occurrence of AF after flutter ablation in follow-up of 12±11 (6-60) months or median 14 months. Relations among AF occurrence and clinical and procedural factors were analysed retrospectively by a Cox proportional hazard method. Result:Atrial flutter in all of the 56 patients were successfully ablated. After median 14 months of follow-up 15 patients experienced AF,and 3 of them progressed into chronic AF.Patients with post-ablation AF were older than those without post-ablation AF (57.1±13.6 years vs 42.3±11.2 years, P<0.05) and they had longer high right atrium to coronary sinus conduction times before(98.4±17.1 ms vs 67.8±16.5 ms, P=0.001) and after ablation(93.1±18.4 ms vs 70.2±19.7 ms, P=0.005). Cox proportional hazard analysis revealed that previous AF(hazard ratio:2.3, 95%CI 1.425-4.632, P=0.02) and intra-atrial conduction time from high right atrium to coronary sinus during sinus rhythm over 90 ms (hazard ratio:1.7, 95%CI 1.215-3.758, P=0.03) were independent of predictors of postablation AF. Conclusions:Intra-atrial conduction delay exists in patients with occurrence of AF after flutter ablation and it is an important electrophysiological factor predicting AF after successful flutter ablation.