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目的:本研究旨在探讨右心房横径(RAD)是否可以预测持续性心房颤动射频消融术后复发。方法:纳入2009年1月至2011年12月,在北京安贞医院行导管射频消融术的持续性心房颤动患者共274例。消融策略为双侧环肺静脉隔离(PVI)基础上加行左心房顶部、二尖瓣峡部和三尖瓣峡部线性消融。术后以常规心电图和动态心电图随访患者心律失常复发情况。运用回归分析方法甄别与心律失常复发相关的危险因素并检测其预测效力。结果:术后随访平均24个月,共有174例消融术后复发。与未复发组相比,复发组左心房内径(LAD)显著性增大[(44.6±5.4)vs.(42.8±5.8)mm;P=0.009],但是两组的RAD差异无统计学意义,[(43.5±5.6)vs.(43.7±6.1)mm;P=0.796)。单因素Cox回归分析显示女性(HR=0.475,95%CI:0.260~0.867,P=0.015)﹑体质量指数(HR=1.063,95%CI:0.988~1.143,P=0.100)和LAD(HR=1.064,95%CI:1.015~1.115,P=0.010)是心房颤动术后复发的危险因素,而RAD不是心房颤动术后复发的危险因素。多因素Cox回归分析显示LAD(HR=1.053,95%CI:1.000~1.109,P=0.050)和女性(HR=0.418,95%CI:0.213~0.819,P=0.011)可以独立预测心房颤动消融术后复发。结论:右心房大小不能独立预测持续性心房颤动消融术后复发,推测有其他潜在的机制参与此类心房颤动的发生与维持。
PURPOSE: This study was designed to investigate whether right atrial diameter (RAD) can predict recurrence of persistent atrial fibrillation after radiofrequency ablation. Methods: A total of 274 consecutive patients with atrial fibrillation who underwent catheter ablation at Anzhen Hospital in Beijing from January 2009 to December 2011 were enrolled. The ablation strategy was based on bilateral circumferential pulmonary vein isolation (PVI) plus linear ablation of the left atrium, mitral isthmus, and tricuspid isthmus. Postoperative patients with conventional electrocardiogram and ECG follow-up of arrhythmia recurrence. Regression analysis was used to identify the risk factors associated with the recurrence of arrhythmia and test its predictive power. Results: All patients were followed up for an average of 24 months. A total of 174 patients relapsed after ablation. The left atrial appendage (LAD) in the recurrent group was significantly higher than that in the non-recurrent group (44.6 ± 5.4 vs. 42.8 ± 5.8 mm, P = 0.009), but there was no significant difference in RAD between the two groups [(43.5 ± 5.6) vs. (43.7 ± 6.1) mm; P = 0.796). Univariate Cox regression analysis showed that the body mass index (HR = 1.063, 95% CI: 0.988-1.1431, P = 0.100) and LAD (HR = 0.475, 95% CI: 0.260-0.867, P = 0.015) 1.064, 95% CI: 1.015 to 1.115, P = 0.010) were risk factors for postoperative recurrence of atrial fibrillation, whereas RAD was not a risk factor for postoperative recurrence of atrial fibrillation. Multivariate Cox regression analysis showed that LAD (HR = 1.053, 95% CI: 1.000-1.109, P = 0.050) and female (HR = 0.418, 95% CI: 0.213-0.819, P = 0.011) could independently predict atrial fibrillation ablation After the recurrence. CONCLUSIONS: Right atrial size can not predict independently the recurrence of persistent atrial fibrillation after ablation, suggesting that other potential mechanisms are involved in the occurrence and maintenance of such atrial fibrillation.