论文部分内容阅读
目的评价导管消融治疗迷宫术后复发房性心动过速(房速)的中、远期疗效,探讨房速复发的相关因素。方法纳入2010年4月至2015年6月在广东省人民医院接受导管消融治疗的迷宫术后复发房速患者59例。应用三维标测系统进行高密度电解剖标测,结合拖带标测指导导管消融。术后定期随访,采用多因素Cox比例风险回归模型分析导管消融治疗迷宫术后房速复发的危险因素。结果共记录到88种房速,其中1例患者房速为短阵性发作,与窦性心律交替出现,难以进行电解剖标测及拖带标测。平均每例患者有(1.49±0.75)种房速,以折返性房速多见,占76.1%(67/88),局灶性房速占22.7%(20/88)。59例患者中,56例(94.9%)即时消融成功。术后平均随访(30.8±17.7)个月,首次导管消融治疗后3例患者即时消融失败,12例复发,术后复发时间为3.5(1.3,12.0)个月,消融成功率为74.6%(44/59)。6例患者接受再次导管消融治疗,二次导管消融治疗后总体成功率为79.7%(47/59)。多因素分析提示左心房内径为预测复发的独立危险因素(HR1.108,95%CI 1.002~1.226,P=0.045)。结论迷宫术后复发房速患者行导管消融治疗安全、有效,左心房内径是房速消融术后复发的独立危险因素。
Objective To evaluate the medium and long term efficacy of catheter ablation in the treatment of recurrent atrial tachycardia after a maze procedure and to explore the related factors of the recurrence of atrial tachycardia. Methods A total of 59 patients with recurrent atrial tachycardia after labyrinthine catheterization in Guangdong Provincial People’s Hospital from April 2010 to June 2015 were enrolled. Application of three-dimensional mapping system for high-density electro-anatomical mapping, combined with tow mapping guide catheter ablation. The patients were followed up regularly. The risk factors of atrial tachycardia recurrence after maze procedure were analyzed by multivariate Cox proportional hazards regression model. Results A total of 88 kinds of atrial tachycardia were recorded, of which 1 case had a short-term atrial tachycardia. Alternating with sinus rhythm, it was difficult to conduct electroanatomic mapping and towing mapping. The average rate of atrial tachycardia per case was 1.49 ± 0.75. The rate of reentry was 76.1% (67/88). The rate of focal atrial tachycardia was 22.7% (20/88). Of the 59 patients, 56 (94.9%) had an immediate ablation. The average follow - up time was 30.8 ± 17.7 months. After the first catheter ablation, 3 patients failed to ablate immediately, and 12 patients relapsed. The recurrence time was 3.5 (1.3, 12.0) months and the success rate of ablation was 74.6% (44) / 59). Six patients underwent re-catheter ablation, with a total success rate of 79.7% (47/59) after secondary catheter ablation. Multivariate analysis suggested that left atrial diameter was an independent risk factor for predicting recurrence (HR 1.108, 95% CI 1.002-1.266, P = 0.045). Conclusions Catheter ablation is safe and effective in the patients with recurrent atrial tachycardia. The left atrium diameter is an independent risk factor for recurrence after atrial tachycardia ablation.