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目的在观察心房颤动(简称房颤)冷冻球囊消融术中迷走反应与术后房颤复发的相关性,分析其可能的机制。方法入选61例阵发性房颤患者,其中男38例,女23例,年龄(58.4±11.7)岁。所有患者术中监测迷走反应,并根据监测结果分为迷走阳性组和阴性组。术后根据Holter和心电图随访房颤复发情况。结果术中监测31例迷走反应阳性(50.8%),30例迷走反应阴性。随访(7.8±2.5)个月,10例房颤复发。其中,迷走阳性组复发率显著低于迷走阴性组(6.4%vs 26.7%,P<0.05)。多因素Cox回归分析提示迷走反应能独立预测冷冻术后房颤复发情况(Wald:4.005,95%CI:0.008~0.951,P=0.045)。结论冷冻术中迷走反应是阵发性房颤患者近中期是否复发的一项预测因子。去迷走神经化可能提高阵发性房颤冷冻消融的成功率。
Objective To observe the correlation between vagal reaction and recurrence of postoperative atrial fibrillation in the treatment of atrial fibrillation (Atrial Fibrillation) and analyze the possible mechanism. Methods A total of 61 patients with paroxysmal atrial fibrillation were enrolled, including 38 males and 23 females, with an average age of 58.4 ± 11.7 years. All patients were monitored during the vagal reaction, and according to the monitoring results were divided into vagal positive group and negative group. Postoperative follow-up Holter and ECG follow-up of atrial fibrillation recurrence. Results The intraoperative monitoring of 31 cases of vagal reaction was positive (50.8%), 30 cases of vagal reaction negative. Follow-up (7.8 ± 2.5) months, 10 cases of atrial fibrillation recurrence. Among them, the recurrence rate of the vagus positive group was significantly lower than that of the vagus negative group (6.4% vs 26.7%, P <0.05). Multivariate Cox regression analysis revealed that vagal reaction independently predicted the recurrence of atrial fibrillation after cryosurgery (Wald: 4.005, 95% CI: 0.008-0.95 1, P = 0.045). Conclusions The vagalization response during cryo-freezing is a predictor of the recent to mid-term recurrence of patients with paroxysmal atrial fibrillation. To vagalization may improve the success rate of paroxysmal atrial fibrillation and cryoablation.