左心房压与心房颤动类型和导管消融术后复发的关系
Atrial fibrillation recurrence post ablation: relation to left atrial pressure
目的 心房颤动(房颤)消融术中测量左心房压(LAP),研究不同类型房颤患者LAP的变化,探讨LAP与消融术后房颤复发的关系.方法 106例初次行房颤导管消融的患者,分为阵发性房颤(Paro-AF)组(62例)和非阵发性房颤(Non-Paro-AF)组(44例),消融术前1 d行超声心动图检查.消融术中通过心导管术测量LAP:Paro-AF组先记录初始窦性心律时LAPSNR,其中46例患者诱发出持续时间>3 min的房颤,记录诱发房颤3 min时LAP3min.Non-Paro-AF组记录初始房颤节律下的LAPNon-paro-AF.结果 Non-Paro-AF组LAPNon-paro-AF高于Paro-AF组初始窦性心律下LAPSNR[(21.77±8.72)mm Hg对(14.40±7.77)mm Hg,P<0.01].Paro-AF组LAP3min高于LAPSNR[(18.30±8.62)mmHg对(13.33±6.55)mm Hg,P<0.01],但仍然明显低于LAPNon-Paro-AF[(18.30±8.62)mm Hg对(21.77±8.72)mm Hg,P<0.01].平均随访(14.15±1.75)个月共有32例(30.19%)患者复发,复发患者LAP测量值显著高于未复发者[(23.56±11.30)mm Hg对(14.82±6.06)mm Hg,P<0.01].单因素回归分析显示左心房内径(LAD)增大、LAP增高和房颤类型是复发的相关因素,多因素回归分析提示LAP和LAD为房颤消融术后复发的独立预测因素.结论 阵发性房颤患者房颤节律下LAP高于窦性心律下LAP,持续性和永久性房颤患者LAP高于阵发性房颤患者.LAP是房颤消融术后复发的独立危险因素之一.
更多Objective To investigate the role of left atrial pressure (LAP) in different type of atrial fibrillation (AF) and recurrence of atrial arrhythmia in patients with AF who underwent catheter ablation. Methods Among the 106 patients included in this study, 62 of them had paroxysmal AF (Paro-AF group), and 44 had persistent or permanent AF ( Non-Paro-AF group). LAP of Paro-AF group was evaluated at sinus rhythm ( LAPSNR ) and three minutes after AF was induced ( LAP3 min ). LAPNon-Paro-AF of Non-Paro-AF group was measured at baseline during the procedure. Results LAPsNR in Paro-AF group was significantly lower than LAPNon-Paro-AF in Non-Paro-AF group [ ( 14. 40 ± 7.77) mm Hg vs(21.77 ± 8.72) mm Hg, P <0. 01 ].In a subgroup patients with Paro-AF whose AF could be induced and maintained more than three minutes,LAP3 min was significantly increased [ ( 13.33 ± 6.55 ) mm Hg vs( 18. 30 ± 8.62 ) mm Hg, P < 0. 01 ], but it was also lower than LAPNon-Parn-AF[ ( 18.30 ± 8. 62 ) mm Hg vs ( 21.77 ± 8. 72 ) mm Hg, P < 0. 01 ]. After amean follow-up of( 14. 15 ± 1.75) months, 32(30. 19% )patients had recurrent atrial arrhythmia in two groups,LAP level was higher in patients with recurrence than those without recurrence [ (23.56 ± 11.30 ) mm Hg vs( 14. 82 ± 6. 06) mm Hg, P < 0. 01 ]. Multivariate Logistic analysis demonstrated that only LAP and LAD were the independent predictor factor for the recurrence among the variables of age, sex, types of AF, LAD, LAP,left ventricular ejection fraction, thickness of left ventricular posterior wall, thickness of interventricular septum, existence of hypertension. Conclusion The LAP was significantly increased after AF was induced in patients with Paro-AF. The LAP was significantly higher in patients with Non-Paro-AF than those with ParoAF. The increased LAP was one of the independent factors for the recurrence of atrial arrhythmia in patients with catheter ablation.
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