作者：周法光，常栋，万兴才，吕佳蓝，邓英建

单位：

厦门大学附属心血管病医院心内四科

Units：

The Fourth Department of Cardiology, Affiliated Cardiovascular Hospital of Xiamen University;

关键词：

心房颤动; 心力衰竭; 射频导管消融; 预后;

Keywords：

Atrial fibrillation;Heart failure;Radiofrequency catheter ablation;Prognosis;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.304

Funds：

福建省科技计划项目（2017D0020）；

摘要：

目的 探讨心力衰竭对持续性心房颤动患者经导管消融术后中长期预后的影响。方法 回顾性选取2017年1月至2020年3月因持续性心房颤动于厦门大学附属心血管病医院心内科行经导管射频消融术的患者215例。根据心力衰竭发生情况将其分为心力衰竭组（n=123）和对照组（n=92）。比较两组一般资料、消融情况、术后随访情况、临床终点事件发生情况。采用Kaplan-Meier法绘制生存曲线，采用多因素Cox比例风险回归分析探讨心力衰竭对持续性心房颤动患者经导管消融术后发生临床终点事件的影响。结果 心力衰竭组女性占比、年龄及术前纽约心脏病协会（NYHA）分级评分、CHA2DS2-VASc评分、平均心室率、肌酐（Cr）、N末端脑钠肽前体（NT-proBNP）高于对照组，术前TC、TG、左心室射血分数（LVEF）低于对照组，术前左心室内径（LVD）、左心房内径（LAD）大于对照组（P<0.05）。两组手术时间、X线暴露时间、消融次数比较，差异无统计学意义（P>0.05）；心力衰竭组应用伊布利特者占比低于对照组（P<0.05）。两组行单纯环肺静脉前庭隔离术、左心房顶部线性消融、左心房后壁BOX线性消融、二尖瓣峡部线性消融、左心房前壁线性消融、碎裂电位消融者占比比较，差异无统计学意义（P>0.05）；心力衰竭组行三尖瓣峡部线性消融者占比高于对照组（P<0.05）。两组随访时间、随访终点时NYHA分级评分、消融并发症发生率、终点心律情况比较，差异无统计学意义（P>0.05）。两组死亡、非计划再住院、卒中发生率比较，差异无统计学意义（P>0.05）。两组生存曲线比较，差异无统计学意义（χ2=1.182,P=0.277）。多因素Cox比例风险回归分析结果显示，心力衰竭不是持续性心房颤动患者经导管消融术后发生临床终点事件的影响因素（P>0.05）。结论 心力衰竭对持续性心房颤动患者经导管消融术后中长期预后无不良影响，临床上对于合并心力衰竭的持续性心房颤动患者可以按照现有指南要求，及时采取经导管射频消融术进行治疗。

Abstract：

Objective To explore the effect of heart failure on the midium and long-term prognosis of patients with persistent atrial fibrillation after transcathether radiofrequency ablation. Methods A total of 215 patients who underwent transcatheter radiofrequency ablation due to persistent atrial fibrillation in the Department of Cardiology of Affiliated Cardiovascular Hospital of Xiamen University from January 2017 to March 2020 was retrospectively selected. According to the occurrence of heart failure, patients were divided into heart failure group（n=123） and control group（n=92）. The general data, ablation, postoperative follow-up, and clinical endpoint events of the two groups were compared. The Kaplan-Meier method was used to draw survival curve. Multivariate Cox proportional risk regression analysis was used to analyze the effect of heart failure on the clinical endpoint events of patients with persistent atrial fibrillation after transcatheter radiofrequency ablation. Results The proportion of women, age and preoperative New York Heart Association（NYHA） grading score, CHA2DS2-VASc score,average ventricular rate, creatinine（Cr）, N-terminal pro-brain natriuretic peptide（NT-proBNP） in the heart failure group were higher than those in the control group, preoperative TC, TG and left ventricular ejection fraction（LVEF） were lower than those in the control group, and preoperative left ventricular diameter（LVD）, left Atrial diameter（LAD） were bigger than those in the control group（P < 0.05）. There was no significant difference in operation time, X-ray exposure time, and ablation times between the two groups（P > 0.05）; the proportion of ibutilide in the heart failure group was lower than that in the control group（P < 0.05）. There was no significant difference in the proportions of simple circumferential pulmonary vein vestibular isolation, linear ablation of the top of the left atrium, linear ablation of the posterior wall of the left atrium BOX, linear ablation of the mitral valve isthmus, linear ablation of the anterior wall of the left atrium,, and fragmentation potential ablation between the two groups（P > 0.05）. The proportion of linear ablation of the tricuspid valve isthmus in the heart failure group was higher than that in the control group（P < 0.05）. There was no significant difference in follow-up time, NYHA grading score at the end point of follow-up, incidence of ablation complications, and end-point heart rhythm between the two groups（P > 0.05）. There was no significant difference in the incidence of death, unplanned readmission and stroke between the two groups（P > 0.05）. There was no significant difference in survival curves between the two groups（χ2=1.182, P=0.277）. Multivariate Cox proportional risk regression analysis showed that heart failure was not an influencing factor for the clinical endpoint events of patients with persistent atrial fibrillation after transcatheter radiofrequency ablation（P > 0.05）. Conclusion Heart failure has no adverse effect on the midium and long-term prognosis of patients with persistent atrial fibrillation after transcatheter radiofrequency ablation. In clinical practice, patients with persistent atrial fibrillation and heart failure can undergo transcatheter radiofrequency ablation in a timely manner according to the requirements of existing guidelines.

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