CAJ | 학술논문

目的探讨影响心房颤动(房颤)患者导管消融术后远期(3年以上)疗效及其相关因素.方法随访2004年1月至2009年3月间在上海薪华医院心内科行单次导管消融术房颤患者,术后门诊定期常规心电图及24 h动态心电图检查,电话及门诊随访并记录结果与时间.房颤复发定义为:患者在空白期(术后3个月)以后的随访期内心电图和(或)24 h动态心电图记录房性心律失常[房颤、心房扑动(房扑)、房性心动过速(房速)]持续时间≥30 s.Cox多因素回归分析其术前基础疾病、CHADS2评分(有慢性心力衰竭、高血压、年龄≥75岁、糖尿病各计1分,既往有卒中或短暂性脑缺血发作计2分)等与术后远期结果的关系.结果入选280例患者,50例失访,3例死亡,取得有效数据227例(男性132例,女性95例),随访时间为51(41,56)个月,其中复发109例,房颤消融术后≥3年的总复发率为48.0％(109/227).多因素Cox回归分析显示高CHADS2评分(HR:1.417,95％ CI1.194～1.682,P＜0.001)与房颤消融未终止(HR:2.077,95％ CI:1.380～3.126,P=0.043)是房颤消融术后复发的预测因素.房颤消融终止组复发率为41.0％ (75/183),而消融未终止组复发率则高达77.3％(34/44).在消融终止组中,CHADS2评分≥3分的患者复发率为80.0％ (12/15),中位房颤无复发期为12个月.在术中消融未终止组:CHADS2评分=0分房颤患者,复发率为60.0％ (6/10),中位无复发期为30个月;CHADS2评分=1～2分房颤患者,复发率为77.8％ (21/27),其中位无复发期为12个月;CHADS2评分≥3分患者,复发率100％ (7/7),中位无复发期仅为6个月,且在2年内全部复发.结论房颤患者术前CHADS2评分是房颤患者消融术后复发的预测因素.患者术前CHADS2评分越高,其复发率也越高,中位无复发期也越短.
목적 탐토영향심방전동(방전)환자도관소융술후원기(3년이상)료효급기상관인소.방법 수방2004년1월지2009년3월간재상해신화의원심내과행단차도관소융술방전환자,술후문진정기상규심전도급24 h동태심전도검사,전화급문진수방병기록결과여시간.방전복발정의위:환자재공백기(술후3개월)이후적수방기내심전도화(혹)24 h동태심전도기록방성심률실상[방전、심방복동(방복)、방성심동과속(방속)]지속시간≥30 s.Cox다인소회귀분석기술전기출질병、CHADS2평분(유만성심력쇠갈、고혈압、년령≥75세、당뇨병각계1분,기왕유졸중혹단잠성뇌결혈발작계2분)등여술후원기결과적관계.결과 입선280례환자,50례실방,3례사망,취득유효수거227례(남성132례,녀성95례),수방시간위51(41,56)개월,기중복발109례,방전소융술후≥3년적총복발솔위48.0％(109/227).다인소Cox회귀분석현시고CHADS2평분(HR:1.417,95％ CI1.194～1.682,P＜0.001)여방전소융미종지(HR:2.077,95％ CI:1.380～3.126,P=0.043)시방전소융술후복발적예측인소.방전소융종지조복발솔위41.0％ (75/183),이소융미종지조복발솔칙고체77.3％(34/44).재소융종지조중,CHADS2평분≥3분적환자복발솔위80.0％ (12/15),중위방전무복발기위12개월.재술중소융미종지조:CHADS2평분=0분방전환자,복발솔위60.0％ (6/10),중위무복발기위30개월;CHADS2평분=1～2분방전환자,복발솔위77.8％ (21/27),기중위무복발기위12개월;CHADS2평분≥3분환자,복발솔100％ (7/7),중위무복발기부위6개월,차재2년내전부복발.결론 방전환자술전CHADS2평분시방전환자소융술후복발적예측인소.환자술전CHADS2평분월고,기복발솔야월고,중위무복발기야월단.
Objective To investigate the association between CHADS2 score and long-term (≥ 3years) outcomes post catheter ablation in patients with atrial fibrillation (AF).Methods AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up.AF recurrence was defined as the occurrence of atrial arrhythmias (AF,atrial flutter and atrial tachycardia) recorded by electrocardiogram monitor (≥ 30seconds) after ablation during follow-up period (after 3 months blanking period).The relationship between baseline clinical and echocardiographic characteristics and the time to recurrence during follow-up was evaluated using Cox multivariate analysis.Results A total of 280 patients who received single catheter ablation procedure were included in the study,3 patients died and there were 50 patients lost to follow-up.A total of 227 patients with AF (163 paroxysmal and 64 non-paroxysmal) were enrolled in the final analysis.During a median follow-up of 51 months (41-56 months),109 patients experienced AF recurrences and the recurrence rate after catheter ablation (≥3 years) was 48.0％ (109/227).Cox multivariate analysis showed that the high CHADS2 score (HR:1.417,95％ CI 1.194-1.682,P ＜0.001) and AF nontermination during ablation (HR:2.077,95％ CI 1.380-3.126,P =0.043) were risk factors of AF recurrence.AF recurrence rates in the termination and non-termination group were 41.0％ (75/183) and 77.3％ (34/44),respectively.In the AF termination group,the recurrence rates and the median recurrence free time in patients with CHADS2 score≥3 were 80.0％ (12/15) and 1 year,respectively.In the non-AF termination group,the recurrence rates in patients with CHADS2 score =0,CHADS2 score =1-2 and CHADS2 score≥3 were 60.0％ (6/10),77.8％ (21/27) and 100％ (7/7),respectively; the median recurrence free time of patients with CHADS2 score =0,CHADS2 score =1-2 and CHADS2 score ≥3 were 30 months,12 months and 6 months,respectively.Conclusions CHADS2 score is a predictor of AF recurrences after catheter ablation.Patients with high CHADS2 score is associated with higher risk of longterm (≥3 years) AF recurrences.