阵发性房颤射频消融术后空白期内房性心律失常与房颤远期复发的关系

目的 探讨阵发性房颤射频消融术后3个月（“空白期”）内房性心律失常的发作趋势与远期复发的关系.方法 入选在我院接受首次环肺静脉电隔离射频消融术的阵发性房颤患者50例,并于术后3个月内每月行24h动态心电图检查,同时进行术后定期临床随访和监测12个月.根据术后第12个月体表心电图、24h动态心电图监测及临床随访结果,分为房颤复发组和无复发组,比较复发组患者与无复发组患者术后3个月内房性心律失常发生率及随着时间推移两组房性心律失常的发作趋势.结果 术后第12个月体表心电图及24h动态心电图统计结果显示,房颤复发率为36.0％（18/50）,所有心电图中出现快速型房性心律失常心电图为26.9％,其中房颤20.2％、房扑2.0％、房速4.7％;房性早搏20.1％;窦性心动过缓2.0％.复发组患者术后3个月内房性心律失常的发生率高于无复发组（41.1％比10.2％,P＜0.05）,复发组患者术后3个月内房性心律失常的发生率维持在较高水平（术后3个月分别为44.4％、41.8％、38.5％,P＞0.05）.无复发组患者术后3个月可出现房颤复发,随着时间推移房性心律失常的发生率呈降低趋势（术后3个月分别为18.7％、10.5％、4.4％,P＜0.01）.结论 早期复发不能代表消融失败和晚期复发,但早期房性心律失常发作频繁,则晚期房颤复发的危险性增加.

The relationship between atrial arrhythmia during three months after atrial fibrillation ablation in patients with paroxysmal atrial fibrillation and the long-term follow-up outcomes

Objective To investigate the relationship between the trend of atrial arrhythmia during three months （blanking period） after ablation and long-term recurrence.Methods 50 patients with paroxysmal atrial fibrillation were received the primary circumferential pulmonary vein isolation in our hospital,and they were also received 24 hours holter examination monthly during the blanking period,and regular clinical follow-up and monitoring for 12 months after ablation.According to the electrocardiogram and the 24 hours Holter examination results and the clinical follow-up outcomes at the twelfth months,all the patients were divided into atrial fibrillation recurrence group and non recurrence group.Compared the atrial arrhythmia rates and the occurrence trend between recurrence group and non recurrence group within three months.Results Based on the twelfth months of electrocardiogram and 24 hours holter follow-up outcomes,the results showed atrial fibrillation recurrence rate was 36％ （18/50）.All ECG in rapid atrial arrhythmia ECG was 26.9％,of which atrial flutter in 20.2％,atrial fibrillation in 2.0％,atrial tachycardia in 4.7％.There were 20.1％ atrial premature contraction and 2％ sinus bradycardia.During the blanking period atrial arrhythmia rates in the recurrent group was higher than that non recurrent group （41.1％ vs 10.2％,P＜0.05）,and the rates maintained at a high level （sequently：44.4％,41.8％,38.5％,P＞ 0.05）.Non recurrence group could also appear atrial fibrillation during blanking time,but the frequency of the atrial arrhythmia was decreased （sequently：18.7％,10.5％,4.4％,P＜0.01）.Condusion Atrial fibrillation recurrence during that three months is not representative of ablation failure and long-time result,but atrial arrhythmia occurs frequently in that time that can have a high risk of atrial fibrillation recurrence in the long-term follow-up.