心房颤动患者诊断到消融时间与术后复发的相关性研究
Correlation between the diagnosis-to-ablation time and the recurrence after atrial fibrillation ablation
杨正凯 1时星宇 1刘梓瑞 1路瑜 1徐明珠 1周靖 1孙世坤 1邹操1
作者信息
- 1. 苏州大学附属第一医院心血管内科(江苏苏州,215006)
- 折叠
摘要
目的:通过回顾性分析心房颤动(房颤)患者诊断到消融时间(DAT)与术后复发的相关性,探讨房颤患者诊断到消融的最佳时间.方法:选取2017年1月-2022年1月于我院首次行射频消融术的房颤患者,出院后定期通过门诊或电话对其进行随访.针对术后复发的影响因素采用多因素logistic回归分析法;Kaplan-Meier生存曲线用于对房颤消融术后未复发率进行分析.结果:共纳入553例房颤患者,其中持续性房颤占37.1％,女性占44.3％,年龄为(62.3±10.21)岁,DAT为12(3,48)个月,术后随访(26.7±16.36)个月,房颤消融术后总体未复发率为80.3％.logistic回归分析显示,DAT(OR=1.005,95％CI:1.0～1.011,P＜0.05)、持续性房颤(OR=1.952,95％CI:1.160～3.385,P＜0.05)和女性是术后复发的独立危险因素.Kaplan-Meier生存分析表明,房颤伴DAT≤12个月的患者消融术后未复发率明显高于DAT＞12个月的患者(84.8％vs.75.7％,P＜0.05),持续性房颤患者消融术后未复发率明显低于阵发性房颤患者(76.1％vs.82.8％,P＜0.05),而房颤患者男女间消融术后未复发率差别无统计学意义.按照DAT每间隔6个月分成0～6个月组、6～12个月组和＞12个月组:阵发性房颤患者3组间消融术后累积未复发率差异有统计学意义(P＜0.05),DAT0～6个月组和DAT6～12个月组未复发率明显高于DAT＞12个月组(P＜0.05),前两组间差异无统计学意义;持续性房颤患者3组间消融术后的累积未复发率差异有统计学意义(P＜0.05),DAT 0～6个月组明显高于DAT 6～12个月组和DAT＞12个月组(P＜0.05),后两组间差异无统计学意义.结论:房颤患者尽早接受导管消融有较高的未复发率,阵发性房颤患者在DAT＜12个月内、持续性房颤患者在DAT＜6个月内接受导管消融有助于降低术后复发率.
Abstract
Objective:To analyze the correlation between the diagnosis-to-ablation time(DAT)and recurrence after atrial fibrillation(AF)ablation retrospectively,and explore the optimal time of DAT.Methods:Patients with AF who underwent radiofrequency ablation for the first time at our hospital from January 2017 to January 2022 were selected for regular follow-up at an outpatient or by telephone after discharge.Multifactorial logistic regres-sion was used to analyze factors influencing recurrence after AF ablation.The Kaplan-Meier survival curve was used to analyze the non-recurrence rate in AF patients after ablation.Results:A total of 553 patients with AF were enrolled,including 37.1％persistent AF,44.3％female,a mean age of(62.3±10.21)years,the DAT of 12(3,48)months.After the mean follow-up time of(26.7±16.36)months,the non-recurrence rate of AF after abla-tion was 80.3％.Multivariate logistic regression analysis indicated that DAT(OR=1.005,95％CI:1.0-1.011,P＜0.05),persistent AF(OR=1.952,95％CI:1.160-3.385,P＜0.05)and female(OR=1.698,95％CI:1.056-2.731,P＜0.05)was an independent risk factor for recurrence after AF ablation.Kaplan-Meier survival analysis indicated that the non-recurrence rate in the patients with DAT≤12 months was significantly higher than that in the patients with DAT＞12 months(84.8％vs.75.7％,P＜0.05);The non-recurrence rate of persistent AF patients was significantly lower than that of paroxysmal AF patients(76.1％vs.82.8％,P＜0.05).There was no significant difference between males and females in the non-recurrence rate of AF.Patients were divided into the 0-6 months group,6-12 months group,and＞12 months group according to the DAT interval.There was a significant difference in the cumulative non-recurrence rate after ablation among the three groups in patients with paroxysmal AF,and the non-recurrence rate was significantly higher in the DAT 0-6 months group and DAT 6-12 months groups than that in the DAT＞12 months group(P＜0.05),whereas the difference between the former two groups was not statistically significant.In patients with persistent AF,there was a statistically significant difference in the cumulative non-recurrence rate after ablation among the three groups(P＜0.05),and the cumulative non-recurrence rate in the DAT 0-6 months group was significantly higher than that in the DAT 6-12 months group and the DAT＞12 months group(P＜0.05),while there was no statistically significant differ-ence between the latter two groups.Conclusion:Patients with AF who undergo catheter ablation early have higher non-recurrence rates.Catheter ablation in patients with paroxysmal AF within 12 months of DAT and in patients with persistent AF within 6 months of DAT can help to reduce the recurrence rate.
关键词
心房颤动/导管消融/复发/诊断到消融时间Key words
atrial fibrillation/catheter ablation/recurrence/diagnosis-to-ablation time引用本文复制引用
基金项目
苏州市临床重点病种诊疗技术专项(LCZX202103)
苏州市医疗卫生科技创新项目(SKYD2022103)
苏州大学横向课题(H190426)
苏州大学横向课题(H220694)
出版年
2024
NETL
NSTL
万方数据