低静息心率与≥65岁心房颤动患者导管消融术后复发的关系研究
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摘要
背景导管消融术是临床治疗心房颤动(AF)的主要手段,但术后仍存在一定复发风险,而老年AF患者导管消融术后低静息心率(RHR)发生率及复发率均较高。目的探讨低RHR与≥65岁AF患者导管消融术后复发的关系。方法选取2015年1月—2017年10月泰州市人民医院和苏州大学附属第一医院收治的≥65岁并行左心房环肺静脉导管消融术的AF患者82例,根据术前RHR分为A组(<50次/min,n=11)、B组(50～59次/min,n=17)、C组(≥60次/min,n=54);根据术后3个月AF复发情况分为复发组(n=25)和非复发组(n=57)。比较A组、B组、C组患者一般资料〔包括性别、年龄、AF病程、CHADS_2评分、合并症(包括高血压、糖尿病、心力衰竭)、器质性心脏病发生情况〕、左心房直径、左心室射血分数(LVEF)、术后3个月复发率,并比较A、B、C组导管消融术前及术后3个月RHR;比较复发组与非复发组患者一般资料、左心室直径、LVEF、随访1年RHR;低RHR与≥65岁AF患者导管消融术后复发的关系分析采用多因素Logistic回归分析。结果 (1)A、B、C组患者年龄、AF病程、左心房直径及术后3个月复发率比较,差异有统计学意义(P<0.05);A、B、C组患者性别,CHADS_2评分,高血压、糖尿病、心力衰竭及器质性心脏病发生率,LVEF比较,差异无统计学意义(P>0.05)。(2)A组患者术前及术后3个月RHR比较,差异无统计学意义(P>0.05);B、C组患者术后3个月RHR高于术前(P<0.05)。(3)本组患者导管消融术后复发率为30.5%(25/82)。复发组与非复发组患者性别,年龄,AF病程,高血压、糖尿病、心力衰竭、器质性心脏病发生率,LVEF,随访1年RHR比较,差异无统计学意义(P>0.05);复发组患者CHADS_2评分高于非复发组,左心房直径长于非复发组(P<0.05)。(4)多因素Logistic回归分析结果显示,术前RHR<50次/min是≥65岁AF患者导管消融术后复发的独立危险因素(P<0.05)。结论≥65岁AF患者导管消融术后复发率较高,而术前RHR<50次/min是≥65岁AF患者导管消融术后复发的独立危险因素,临床上应采取针对性措施控制RHR以降低患者导管消融术后复发风险。
Background Catheter ablation is the main measure to treat atrial fibrillation on clinic,but risk of recurrence after catheter ablation is still subsistent,moreover risks of both low resting heart rate(RHR)and recurrence are relatively high in elderly postoperative atrial fibrillation patients treated by catheter ablation. Objective To investigate the relationship between low RHR and recurrence of atrial fibrillation in postoperative patients(≥ 65 years old)treated by catheter ablation. Methods A total of 82 atrial fibrillation patients(≥ 65 years old)undergoing catheter ablation of left atrium circumferential pulmonary vein were selected in the People's Hospital of Taizhou and the First Affiliated Hospital of Soochow University from January2015 to October 2017,and they were divided into A group(with preoperative RHR less than 50 times per minute,n=11),B group(with preoperative RHR from 50 to 59 times per minute,n=17) and C group(with preoperative RHR equal or over60 times per minute,n=54)according to the preoperative RHR,into recurrence group(n=25)and non-recurrence group(n=57)according to the recurrence of atrial fibrillation 3 months after catheter ablation. General information(including gender,age,course of atrial fibrillation,CHADS_2 score,co-existing diseases such as hypertension,diabetes and heart failure,incidence of organic heart disease),LAD,LVEF and recurrence rate after 3 months after catheter ablation were compared in A group,B group and C group,meanwhile RHR before catheter ablation and 3 months after catheter ablation was compared in A group,B group and C group,respectively;general information,LAD,LVEF and RHR 1 year after followup were compared between recurrence group and non-recurrence group;multivariate Logistic regression analysis was used to analyze the relationship between low RHR and recurrence of atrial fibrillation in postoperative patients(≥ 65 years old)treated by catheter ablation. Results(1)There was statistically significant difference in age,course of atrial fibrillation,LAD and recurrence rate after 3 months after catheter ablation in A group,B group and C group,respectively(P<0.05),but there was no statistically significant difference in gender,CHADS_2 score,incidence of hypertension,diabetes,heart failure or organic heart disease,or LVEF in A group,B group and C group(P>0.05).(2)Compared with RHR before catheter ablation,RHR in A group was not statistically significantly different 3 months after catheter ablation(P>0.05),while RHR in B group and C group was statistically significantly higher 3 months after catheter ablation,respectively(P<0.05).(3)The recurrence rate was 30.5%. There was no statistically significant difference in gender,age,course of atrial fibrillation,incidence of hypertension,diabetes,heart failure or organic heart disease,LVEF or RHR 1 year after follow-up between recurrence group and non-recurrence group(P>0.05);CHADS_2 score in recurrence group was statistically significantly higher than that in nonrecurrence group,LAD in recurrence group was statistically significantly longer than that in non-recurrence group(P<0.05).(4)Multivariate Logistic regression analysis results showed that,preoperative RHR less than 50 times per minute was one of independent risk factors of recurrence of atrial fibrillation in postoperative patients(≥ 65 years old)treated by catheter ablation(P<0.05). Conclusion Recurrence rate of atrial fibrillation is relatively high in postoperative patients( ≥ 65 years old)treated by catheter ablation,and preoperative RHR less than 50 times per minute is the independent risk factor,thus we should adopt targeted interventions to control RHR on clinic,to reduce the risk of recurrence.
Background Catheter ablation is the main measure to treat atrial fibrillation on clinic,but risk of recurrence after catheter ablation is still subsistent,moreover risks of both low resting heart rate(RHR)and recurrence are relatively high in elderly postoperative atrial fibrillation patients treated by catheter ablation. Objective To investigate the relationship between low RHR and recurrence of atrial fibrillation in postoperative patients(≥ 65 years old)treated by catheter ablation. Methods A total of 82 atrial fibrillation patients(≥ 65 years old)undergoing catheter ablation of left atrium circumferential pulmonary vein were selected in the People's Hospital of Taizhou and the First Affiliated Hospital of Soochow University from January2015 to October 2017,and they were divided into A group(with preoperative RHR less than 50 times per minute,n=11),B group(with preoperative RHR from 50 to 59 times per minute,n=17) and C group(with preoperative RHR equal or over60 times per minute,n=54)according to the preoperative RHR,into recurrence group(n=25)and non-recurrence group(n=57)according to the recurrence of atrial fibrillation 3 months after catheter ablation. General information(including gender,age,course of atrial fibrillation,CHADS_2 score,co-existing diseases such as hypertension,diabetes and heart failure,incidence of organic heart disease),LAD,LVEF and recurrence rate after 3 months after catheter ablation were compared in A group,B group and C group,meanwhile RHR before catheter ablation and 3 months after catheter ablation was compared in A group,B group and C group,respectively;general information,LAD,LVEF and RHR 1 year after followup were compared between recurrence group and non-recurrence group;multivariate Logistic regression analysis was used to analyze the relationship between low RHR and recurrence of atrial fibrillation in postoperative patients(≥ 65 years old)treated by catheter ablation. Results(1)There was statistically significant difference in age,course of atrial fibrillation,LAD and recurrence rate after 3 months after catheter ablation in A group,B group and C group,respectively(P<0.05),but there was no statistically significant difference in gender,CHADS_2 score,incidence of hypertension,diabetes,heart failure or organic heart disease,or LVEF in A group,B group and C group(P>0.05).(2)Compared with RHR before catheter ablation,RHR in A group was not statistically significantly different 3 months after catheter ablation(P>0.05),while RHR in B group and C group was statistically significantly higher 3 months after catheter ablation,respectively(P<0.05).(3)The recurrence rate was 30.5%. There was no statistically significant difference in gender,age,course of atrial fibrillation,incidence of hypertension,diabetes,heart failure or organic heart disease,LVEF or RHR 1 year after follow-up between recurrence group and non-recurrence group(P>0.05);CHADS_2 score in recurrence group was statistically significantly higher than that in nonrecurrence group,LAD in recurrence group was statistically significantly longer than that in non-recurrence group(P<0.05).(4)Multivariate Logistic regression analysis results showed that,preoperative RHR less than 50 times per minute was one of independent risk factors of recurrence of atrial fibrillation in postoperative patients(≥ 65 years old)treated by catheter ablation(P<0.05). Conclusion Recurrence rate of atrial fibrillation is relatively high in postoperative patients( ≥ 65 years old)treated by catheter ablation,and preoperative RHR less than 50 times per minute is the independent risk factor,thus we should adopt targeted interventions to control RHR on clinic,to reduce the risk of recurrence.
引文
[1]侯军龙,魏亚静.冷冻球囊消融术与射频消融术治疗心房颤动有效性和安全性的比较研究[J].实用心脑肺血管病杂志,2016,24(1):111-114.DOI:10.3969/j.issn.1008-5971.2016.01.033.
[2]EFREMIDIS M,LETSAS K P,GEORGOPOULOS S,et al.Safety,long-term outcomes and predictors of recurrence following a single catheter ablation procedure for atrial fibrillation[J].Acta Cardiol,2018:1-6.DOI:10.1080/00015385.2018.1494114.
[3]DIEMBERGER I,GENOVESI S,MASSARO G,et al.Metaanalysis of clinical outcomes of electrical cardioversion and catheter ablation in patients with atrial fibrillation and chronic kidney disease[J].Curr Pharm Des,2018,24(24):2794-2801.DOI:10.2174/1381612824666180829112019.
[4]葛兴,陈喆,李超,等.应用三维心腔内超声减少心房颤动经导管射频消融术围术期并发症的研究进展[J].实用心脑肺血管病杂志,2017,25(11):1-4.DOI:10.3969/j.issn.1008-5971.2017.11.001.
[5]SHARASHOVA E,WILSGAARD T,L?CHEN M L,et al.Resting heart rate trajectories and myocardial infarction,atrial fibrillation,ischaemic stroke and death in the general population:The Troms?Study[J].Eur J Prev Cardiol,2017,24(7):748-759.DOI:10.1177/2047487316688983.
[6]ZHAO J,LIU T,LI G.Relationship between two arrhythmias:sinus node dysfunction and atrial fibrillation[J].Arch Med Res,2014,45(4):351-355.DOI:10.1016/j.arcmed.2014.04.005.
[7]KONECNY T,BRADY P A,PARK J Y,et al.Usefulness of heart rate control in atrial fibrillation patients with obstructive sleep apnea[J].Am J Cardiol,2018,122(9):1482-1488.DOI:10.1016/j.amjcard.2018.07.030.
[8]陈英伟,李华,陈晓杰,等.年龄对心房颤动患者导管消融术长期预后的影响[J].中华老年医学杂志,2016,35(12):1283-1287.DOI:10.3760/cma.j.issn.0254-9026.2016.12.007.
[9]陈妍君,许广莉,贺钦,等.心房颤动对非卒中患者认知功能影响的研究进展[J].实用心脑肺血管病杂志,2016,24(9):114-117.DOI:10.3969/j.issn.1008-5971.2016.09.031.
[10]ALADIN A I,AL RIFAI M,RASOOL S H,et al.Relation of resting heart rate to incident atrial fibrillation(from the Henry ford hospital exercise testing project)[J].Am J Cardiol,2017,119(2):262-267.DOI:10.1016/j.amjcard.2016.09.047.
[11]JACKSON L R 2nd,RATHAKRISHNAN B,CAMPBELL K,et al.Sinus Node Dysfunction and Atrial Fibrillation:A Reversible Phenomenon?[J].Pacing Clin Electrophysiol,2017,40(4):442-450.DOI:10.1111/pace.13030.
[12]CHEN Z,YANG Y,ZOU C,et al.Low heart deceleration capacity imply higher atrial fibrillation-free rate after ablation[J].Sci Rep,2018,8(1):5537.DOI:10.1038/s41598-018-23970-7.
[13]JIN X,PAN J K,WU H L,et al.Are left ventricular ejection fraction and left atrial diameter related to atrial fibrillation recurrence after catheter ablation?:A meta-analysis[J].Medicine(Baltimore),2018,97(20):e10822.DOI:10.1097/MD.0000000000010822.
[14]SABBAG A,BERKOVITCH A,SIDI Y,et al.Poor Heart Rate Recovery Is Associated With the Development of New-Onset Atrial Fibrillation in Middle-Aged Adults[J].Mayo Clin Proc,2016,91(12):1769-1777.DOI:10.1016/j.mayocp.2016.08.012.
[15]VLACHOS K,LETSAS K P,KORANTZOPOULOS P,et al.Areview on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation[J].J Geriatr Cardiol,2015,12(5):547-554.DOI:10.11909/j.issn.1671-5411.2015.05.005.
[16]谷祥婷,黄锐.心房颤动发病机制和维持机制的研究进展[J].实用心脑肺血管病杂志,2019,27(1):112-115,120.DOI:10.3969/j.issn.1008-5971.2019.01.025.
[2]EFREMIDIS M,LETSAS K P,GEORGOPOULOS S,et al.Safety,long-term outcomes and predictors of recurrence following a single catheter ablation procedure for atrial fibrillation[J].Acta Cardiol,2018:1-6.DOI:10.1080/00015385.2018.1494114.
[3]DIEMBERGER I,GENOVESI S,MASSARO G,et al.Metaanalysis of clinical outcomes of electrical cardioversion and catheter ablation in patients with atrial fibrillation and chronic kidney disease[J].Curr Pharm Des,2018,24(24):2794-2801.DOI:10.2174/1381612824666180829112019.
[4]葛兴,陈喆,李超,等.应用三维心腔内超声减少心房颤动经导管射频消融术围术期并发症的研究进展[J].实用心脑肺血管病杂志,2017,25(11):1-4.DOI:10.3969/j.issn.1008-5971.2017.11.001.
[5]SHARASHOVA E,WILSGAARD T,L?CHEN M L,et al.Resting heart rate trajectories and myocardial infarction,atrial fibrillation,ischaemic stroke and death in the general population:The Troms?Study[J].Eur J Prev Cardiol,2017,24(7):748-759.DOI:10.1177/2047487316688983.
[6]ZHAO J,LIU T,LI G.Relationship between two arrhythmias:sinus node dysfunction and atrial fibrillation[J].Arch Med Res,2014,45(4):351-355.DOI:10.1016/j.arcmed.2014.04.005.
[7]KONECNY T,BRADY P A,PARK J Y,et al.Usefulness of heart rate control in atrial fibrillation patients with obstructive sleep apnea[J].Am J Cardiol,2018,122(9):1482-1488.DOI:10.1016/j.amjcard.2018.07.030.
[8]陈英伟,李华,陈晓杰,等.年龄对心房颤动患者导管消融术长期预后的影响[J].中华老年医学杂志,2016,35(12):1283-1287.DOI:10.3760/cma.j.issn.0254-9026.2016.12.007.
[9]陈妍君,许广莉,贺钦,等.心房颤动对非卒中患者认知功能影响的研究进展[J].实用心脑肺血管病杂志,2016,24(9):114-117.DOI:10.3969/j.issn.1008-5971.2016.09.031.
[10]ALADIN A I,AL RIFAI M,RASOOL S H,et al.Relation of resting heart rate to incident atrial fibrillation(from the Henry ford hospital exercise testing project)[J].Am J Cardiol,2017,119(2):262-267.DOI:10.1016/j.amjcard.2016.09.047.
[11]JACKSON L R 2nd,RATHAKRISHNAN B,CAMPBELL K,et al.Sinus Node Dysfunction and Atrial Fibrillation:A Reversible Phenomenon?[J].Pacing Clin Electrophysiol,2017,40(4):442-450.DOI:10.1111/pace.13030.
[12]CHEN Z,YANG Y,ZOU C,et al.Low heart deceleration capacity imply higher atrial fibrillation-free rate after ablation[J].Sci Rep,2018,8(1):5537.DOI:10.1038/s41598-018-23970-7.
[13]JIN X,PAN J K,WU H L,et al.Are left ventricular ejection fraction and left atrial diameter related to atrial fibrillation recurrence after catheter ablation?:A meta-analysis[J].Medicine(Baltimore),2018,97(20):e10822.DOI:10.1097/MD.0000000000010822.
[14]SABBAG A,BERKOVITCH A,SIDI Y,et al.Poor Heart Rate Recovery Is Associated With the Development of New-Onset Atrial Fibrillation in Middle-Aged Adults[J].Mayo Clin Proc,2016,91(12):1769-1777.DOI:10.1016/j.mayocp.2016.08.012.
[15]VLACHOS K,LETSAS K P,KORANTZOPOULOS P,et al.Areview on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation[J].J Geriatr Cardiol,2015,12(5):547-554.DOI:10.11909/j.issn.1671-5411.2015.05.005.
[16]谷祥婷,黄锐.心房颤动发病机制和维持机制的研究进展[J].实用心脑肺血管病杂志,2019,27(1):112-115,120.DOI:10.3969/j.issn.1008-5971.2019.01.025.