典型心房扑动对心房颤动导管消融复发的影响

目的 评价典型心房扑动(房扑)对心房颤动(房颤)导管消融复发的影响.方法 120例药物治疗无效的阵发性房颤患者在三维电解剖标测系统和肺静脉环状标测电极导管联合指导下行环肺静脉电隔离.其中17例(14.2%)合并典型房扑(房扑组,其余作为对照组),行三尖瓣环峡部消融,三尖瓣环峡部消融终点为三尖瓣环峡部双向阻滞.房颤复发定义为导管消融3个月后发生房性快速心律失常.结果 房扑组房颤病程(9.8±10.7)年,长于对照组(5.9±6.3)年,差异有统计学意义(P=0.036).房扑组与对照组相比,年龄、性别、合并器质性心脏病、左心房直径、左心室射血分数差异无统计学意义.随访91～401(237±79)d,房扑组房颤复发率为47.1%,对照组房颤复发率为12.6%,两组间差异有统计学意义(P=0.001).经校正年龄、房颤病程、合并器质性心脏病、左心房直径等因素,Cox多因素分析发现消融术前合并房扑是房颤复发的独立危险因素(危险比3.52,95%可信区间1.32～9.34,P=0.012).结论 典型房扑可能增加房颤导管消融术后房颤的复发,房颤导管消融前应对患者是否合并典型房扑进行认真评价.

Impact of typical atrial flutter on the recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation

Objective This study sought to investigate the impact of typical atrial flutter(AFL)on the recurrence of atrial fibrillation(AF)after catheter ablation of paroxysmal AF.Methods One hundred and twenty consecutive patients with paroxysmal AF undergoing circumferential pulmonary vein isolation guided by 3D mapping system and Lasso catheter were enrolled in the retrospective study.Cavotricuspid isthmus were targeted and bilateral block were achieved in 17(14.2%)patients who were combined with typical AFL AF recurrence was defined as atrial tachyarrhythmias beyond three months washout period.Results The mean AF duration Was significantly longer in patients with typical AFL(AFL group)than those without AFLnon-AFL group,(9.8±10.7)yrs vs(5.9±6.3)yrs,P=0.036].The age,gender,structural heart disease,left atrial size,left ventricular ejection fraction did not differ between the two groups.After a mean follow-up of 91～401(237±79)days,the incidence of recurrence was significantly higher in the AFL group than in the non-AFL group(47.1%vs12.6%,P=0.001).Adjusted for age,AF duration,structural heart disease and left atrial size,Cox regression analysis revealed that typical AFL was an independent predictor of recurrence(hazard ratio 3.52,95%confidence interval 1.32～9.34,P=0.012).Condusion Because typical AFL might increase the recurrence rate of after catheter ablation,typical AFL should be prudently evaluated before the ablation procedure.