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目的:分析心房颤动(简称房颤)经导管射频消融术中出现心房扑动、房性心动过速等规律性快速性房性心律失常(RATs)的预测因素。方法:首次行经导管射频消融治疗的497例房颤患者(阵发性房颤333例,持续性和(或)永久性房颤164例)在三维标测系统及环状标测电极导管指导下行经导管射频消融治疗(包括环肺静脉电隔离、线性消融和(或)碎裂电位消融)。术中记录RATs的发生情况,并分析RATs的可能影响因素。结果:术中共有163例患者[32.8%;阵发性房颤92例,持续性和(或)永久性房颤71例]出现195种RATs,持续性和(或)永久性房颤术中RATs的发生率显著高于阵发性房颤(43.3%比27.6%,P<0.001)。单因素分析发现心脏外科术后(P<0.001)、术前有RATs(P=0.010)、持续性和(或)永久性房颤(P<0.001)、左房内径增大(P<0.001)、左室射血分数降低(P=0.018)是房颤术中出现RATs的影响因素。Logistic多因素回归分析发现心脏外科术后[优势比(OR)=8.14,95%可信区间(CI):1.69～39.1,P=0.009]、术前有RATs[OR=2.15,95%CI:1.35～3.42,P=0.001]、持续性和(或)永久性房颤[OR=1.71,95%CI:1.06～2.76,P=0.029]、左房内径[OR=1.04,95%CI:1.01～1.08,P=0.025]是术中出现RATs的独立预测因素。结论:房颤射频消融术中常出现RATs,心脏外科术后、术前有RATs、持续性和(或)永久性房颤、左房内径是术中出现RATs的独立预测因素。
OBJECTIVE: To analyze the predictive factors of atrial tachycardia and atrial tachycardia regular atrial tachyarrhythmias (RATs) during catheterized radiofrequency catheter ablation of atrial fibrillation (AF). METHODS: A total of 497 patients with atrial fibrillation (333 cases of paroxysmal atrial fibrillation, 164 cases of persistent and / or permanent atrial fibrillation) undergoing catheter ablation were instructed in the first time under the guidance of a three-dimensional mapping system and a ring- Transcatheter radiofrequency ablation (including circumferential pulmonary vein isolation, linear ablation and / or ablation of fragmentation potential). The incidence of RATs was recorded and the possible influencing factors of RATs were analyzed. RESULTS: A total of 195 RATs were observed in 163 patients (32.8%; 92 patients with paroxysmal atrial fibrillation, 71 patients with persistent and / or permanent atrial fibrillation) undergoing continuous and / or permanent AF The incidence of RATs was significantly higher in patients with paroxysmal atrial fibrillation (43.3% vs 27.6%, P <0.001). Univariate analysis showed that there were RATs (P = 0.010), persistent and / or permanent atrial fibrillation (P <0.001) and increased left atrial diameter (P <0.001) after cardiac surgery (P <0.001) , Decreased left ventricular ejection fraction (P = 0.018) were the influencing factors of RATs during AF. Logistic multivariate regression analysis showed that preoperative RATs [OR = 2.15, 95% CI: 1.69 to 39.1, P = 0.009] (OR = 1.71, 95% CI: 1.06-2.76, P = 0.029), left atrial diameter [OR = 1.04, 95% CI: 1.01 ~ 1.08, P = 0.025] were independent predictors of intraoperative RATs. CONCLUSIONS: RATs often occur during radiofrequency ablation of atrial fibrillation. RATs, persistent and / or permanent atrial fibrillation preoperatively after cardiac surgery and left atrial diameter are independent predictors of intraoperative RATs.