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目的分析导管消融术联合心腔内电复律治疗非阵发性心房颤动(房颤)远期复发的影响因素。方法选取2009年1月至2014年12月上海交通大学医学院附属新华医院行多步骤递进式消融后,房颤仍未终止,术中再经静脉导管心腔内电复律法进行电复律的非阵发性房颤患者62例。随访12~48个月,对可能影响远期复发的因素进行分析。结果经导管消融术后持续房颤发作的所有非阵发性房颤患者,经静脉导管心腔内电复律治疗后均转复为窦性心律。根据是否远期复发,将患者分为复发组(26例)和未复发组(36例)。复发组患者的房颤病程显著长于未复发组[60(0.25,360)个月比24(0.25,120)个月,P=0.019],左心室重量指数[(150.16±34.48)g/m~2比(132.97±27.33)g/m~2,P=0.033]、左心房容积[(75.33±32.03)ml比(59.51±22.36)ml,P=0.025]、左心房容积指数[(40.70±15.81)ml/m~2比(32.21±12.76)ml/m~2,P=0.023]均显著高于未复发组,差异均有统计学意义。多因素回归分析显示,房颤病程是术后远期复发的独立危险因素(OR1.017,95%CI 1.003~1.032,P=0.017)。结论导管消融术联合经静脉导管心腔内电复律可将非阵发性房颤成功转复为窦性心律,房颤病程是患者远期复发的独立危险因素。
Objective To analyze the influencing factors of long-term recurrence of non-paroxysmal atrial fibrillation (AF) treated with catheter ablation combined with intracardiac cardioversion. Methods From January 2009 to December 2014, atrial fibrillation was discontinued after multi-step progressive ablation in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Intraoperative venous electrocardiogram 62 cases of non-paroxysmal AF patients. Follow-up 12 to 48 months, the factors that may affect the long-term recurrence were analyzed. Results All non-paroxysmal atrial fibrillation patients who sustained atrial fibrillation after catheter ablation were converted to sinus rhythm after intravenous cardioversion. Patients were divided into recurrence group (n = 26) and non-recurrence group (n = 36) according to whether they were long-term or not. The course of atrial fibrillation was significantly longer in the relapse group than in the non-relapsed group [60 (0.25,360) months vs 24 (0.25,120) months, P = 0.019], LV mass index [(150.16 ± 34.48) g / m ~ The left atrial volume was significantly higher than that of the control group (P <0.05). The left atrial volume [(75.33 ± 32.03) ml vs (59.51 ± 22.36) ml, P = 0.025], left atrial volume index [(40.70 ± 15.81 ) ml / m ~ 2 (32.21 ± 12.76) ml / m ~ 2, P = 0.023] were significantly higher than those without recurrence, the differences were statistically significant. Multivariate regression analysis showed that the duration of atrial fibrillation was an independent risk factor for long-term recurrence (OR1.017, 95% CI 1.003-1.032, P = 0.017). Conclusion Catheter ablation combined with intravenous cardioversion via venous catheter can successfully convert non-paroxysmal atrial fibrillation to sinus rhythm. The course of atrial fibrillation is an independent risk factor for long-term recurrence.