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目的探讨心房颤动(简称房颤)环肺静脉消融术(CPVA)后复发的预测因素。方法109例接受CPVA治疗的房颤患者,在三维电解剖标测系统(CARTO)指导下行环绕同侧肺静脉的线性消融,消融终点为肺静脉电隔离(PVI)。通过对10项临床和消融过程指标进行分析,确定单次CPVA术后早期(<3个月)复发和晚期(≥3个月)复发的预测因素。结果所有患者均实现消融终点,其中59例为通过单一CPVA法(简称强化CPVA法)实现PVI,50例为通过CPVA联合肺静脉口节段性消融法(简称改良CPVA法)实现PVI。49例(45.0%)在术后早期复发房性快速心律失常(ATa)。单因素分析显示左房增大、合并器质性心脏病和改良CPVA法是术后早期复发的预测指标;但经多因素分析后仅有改良CPVA是独立的预测指标(P<0.001;RR4.670;95%CI1.996~10.927)。随访9.1±3.5(4~15)个月,33例(30.3%)在术后晚期复发ATa。单因素分析显示左房增大、合并器质性心脏病和改良CPVA同时也是晚期复发的预测指标,但亦仅有改良CPVA是经多因素分析确定的独立预测指标(P=0.036;RR0.391;95%CI0.613~0.941)。严重并发症包括1例心脏压塞和1例脑卒中。结论在以PVI作为房颤CPVA治疗的消融终点时,无论是术后早期复发或晚期复发,改良CPVA法均是其独立的预测因素。
Objective To investigate the prognostic factors of recurrence of atrial fibrillation (CPF) after circumferential pulmonary vein ablation (CPVA). Methods A total of 109 patients with atrial fibrillation treated with CPVA underwent linear ablation around the ipsilateral pulmonary vein guided by the CARTO system. The end point of ablation was pulmonary vein isolation (PVI). Through the analysis of 10 clinical and abortion indicators, predictors of recurrence in early (<3 months) and late (> 3 months) recurrence of single CPVA were determined. Results All patients achieved end-to-end ablation. Among them, 59 patients achieved PVI by a single CPVA method and 50 patients achieved PVI by CPVA combined with pulmonary vein osseous ablation (modified CPVA method). Forty-nine patients (45.0%) had recurrent atrial tachyarrhythmia (ATa) early after surgery. Univariate analysis showed that left atrial enlargement, combined organic structural heart disease and modified CPVA were the predictors of early postoperative recurrence. However, only modified CPVA was an independent predictor after multiple factor analysis (P <0.001; RR4. 670; 95% CI 1.996 ~ 10.927). A follow-up of 9.1 ± 3.5 months (4-15 months) and 33 patients (30.3%) relapsed late in the postoperative period. Univariate analysis showed that left atrial enlargement, combined organic heart disease, and modified CPVA were also predictors of late recurrence, but only modified CPVA was an independent predictor of multivariate analysis (P = 0.036; RR 0.391 ; 95% CI 0.613 ~ 0.941). Serious complications include one case of cardiac tamponade and one case of stroke. Conclusions When using PVI as the end point of ablation of CPVA for atrial fibrillation, the modified CPVA method is an independent predictor of early postoperative recurrence or late recurrence.