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目的:探讨心房颤动(房颤)递进式射频消融术中射频消融不能终止的患者的临床特点,并进行相关危险因素分析。方法:连续性搜集接受房颤递进式射频消融治疗的患者593例,根据房颤在术中能否被射频消融终止,分为射频消融治疗组(RF组)和射频消融加电复律治疗组(RF+CV组),比较两组临床资料的差异,运用Logistic回归分析房颤不能被射频消融所终止的危险因素。结果:两组在年龄、性别、CHADS评分、CHADS-vasc评分及相关病史方面无明显差异,仅在持续性房颤、发病时间、是否合并糖尿病史方面有显著差异(均P<0.5)。RF+CV组与RF组手术持续时间差异显著[(154.55±47.81)min︰(111.32±42.15)min];左房大小[(45.47±5.25)mm︰(39.13±5.51)mm]、左室舒张末径[(52.11±6.37)mm︰(50.16±5.33)mm]、射血分数[(61.75±11.02)%︰(64.54±8.55)%]、舒张末容积[(132.20±42.51)ml︰(121.30±32.01)ml]、心脏指数[(6.35±1.94)︰(5.66±1.78)]、二尖瓣E峰[(103.90±29.35)︰(87.89±29.17)]及三尖瓣E峰[(59.99±12.42)︰(55.99±12.12)]均差异显著(均P<0.05)。Logistic回归分析显示,房颤不能被射频消融终止与持续性房颤(B=2.927,SE=0.300,Wald=95.291,P=0.000)、糖尿病病史(B=-0.765,SE=0.379,Wald=4.079,P=0.043)、左房大小(B=0.163,SE=0.032,Wald=25.087,P=0.000)相关。对左房直径进行ROC曲线分析,界值为40mm。结论:房颤递进式射频消融术中,左房扩大(大于40mm)、持续性房颤患者,房颤不容易被终止,除进行常规的射频消融治疗以外,患者有接受术中电复律治疗的风险。
Objective: To investigate the clinical features of patients who can not be terminated by radiofrequency ablation in progressive radiofrequency ablation of atrial fibrillation (AF) and analyze the related risk factors. METHODS: A total of 593 patients undergoing progressive radiofrequency ablation of atrial fibrillation were enrolled in this study. According to whether ablation of atrial fibrillation could be terminated by radiofrequency ablation, radiofrequency ablation (RF) group and radiofrequency ablation plus cardioversion (RF + CV group). The differences of clinical data between the two groups were compared. Logistic regression was used to analyze the risk factors of atrial fibrillation that could not be terminated by radiofrequency ablation. Results: There was no significant difference in age, sex, CHADS score, CHADS-vasc score and related medical history between the two groups. Only the duration of persistent atrial fibrillation, onset time and the history of diabetes mellitus were significantly different (all P <0.5). There were significant differences in the duration of surgery between RF + CV group and RF group (154.55 ± 47.81) min: (111.32 ± 42.15) min; left atrial size [(45.47 ± 5.25) mm: (39.13 ± 5.51) mm] (52.11 ± 6.37) mm: (50.16 ± 5.33) mm], ejection fraction [(61.75 ± 11.02)%: (64.54 ± 8.55)%], end diastolic volume [(132.20 ± 42.51) ml︰ ± 32.01) ml], cardiac index [(6.35 ± 1.94) :( 5.66 ± 1.78)], mitral E peak [(103.90 ± 29.35) :( 87.89 ± 29.17]] and tricuspid E [ 12.42) :( 55.99 ± 12.12)] (all P <0.05). Logistic regression analysis showed that AF could not be terminated by radiofrequency ablation with persistent atrial fibrillation (B = 2.927, SE = 0.300, Wald = 95.291, P = 0.000), history of diabetes mellitus (B = -0.765, SE = 0.379, Wald = 4.079 , P = 0.043), left atrial size (B = 0.163, SE = 0.032, Wald = 25.087, P = 0.000). ROC curve analysis of the left atrium diameter, the value of 40mm. CONCLUSION: Atrial fibrillation is not easily terminated in atrial fibrillation progressive radiofrequency ablation with atrial enlargement (greater than 40 mm) in patients with persistent atrial fibrillation. In addition to conventional radiofrequency catheter ablation, patients undergoing elective cardioversion The risk of treatment.