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目的探讨导管消融与药物治疗对肥厚型心肌病(hypertrophic cardiomyopathy,HCM)合并心房颤动(房颤)患者心血管原因住院率的影响。方法连续入选2004年6月至2015年3月于首都医科大学附属北京安贞医院等7家医院首次接受导管消融治疗的48例HCM合并房颤患者作为导管消融组,纳入同期仅接受药物治疗的78例HCM合并房颤患者作为药物治疗组。随访观察患者房颤复发及心血管原因住院情况。结果导管消融组48例患者均顺利完成房颤导管消融,单次术后平均随访(17.6±8.4)个月,16例(33.3%)复发房颤,32例(66.7%)维持窦性心律;药物治疗组平均随访(10.7±8.0)个月,31例(39.7%)转复为窦性心律;导管消融组患者窦性心律维持率显著高于药物治疗组,差异有统计学意义(P=0.003)。与药物治疗组相比,导管消融组的非计划性心血管原因住院率显著降低[2例(4.2%)比17例(21.8%),P=0.001]。Cox多因素分析显示,房颤治疗策略(导管消融/药物治疗,HR 9.082,95%CI 1.130~73.011,P=0.038)和既往心力衰竭史(HR 2.860,95%CI 1.072~7.633,P=0.036)是非计划性心血管原因住院的独立危险因素。结论 HCM合并房颤组患者导管消融治疗的窦性心律维持率及非计划性心血管原因住院率均优于药物治疗组患者,房颤治疗策略和既往心力衰竭史是非计划性心血管原因住院的独立危险因素。
Objective To investigate the effect of catheter ablation and drug treatment on the hospitalized rate of cardiovascular causes in patients with hypertrophic cardiomyopathy (HCM) complicated with atrial fibrillation (AF). Methods A total of 48 HCM patients with atrial fibrillation who underwent catheter ablation at the Beijing Capital Medical University Affiliated Beijing Anzhen Hospital were enrolled in this study consecutively from June 2004 to March 2015 as catheter ablation group and included only drug treatment 78 patients with HCM complicated with atrial fibrillation were treated with drugs. Follow-up observation of patients with recurrent atrial fibrillation and cardiovascular causes of hospitalization. Results Catheter ablation was successfully completed in 48 patients with atrial fibrillation. A single follow - up was (17.6 ± 8.4) months. Atrial fibrillation occurred in 16 patients (33.3%) and sinus rhythm in 32 patients (66.7% The mean follow-up of the drug-treated group was (10.7 ± 8.0) months, and the rate of sinus rhythm maintained in 31 cases (39.7%) was significantly higher than that in the drug-treated group (P = 0.003). Hospitalizations for unplanned cardiovascular causes in the catheter ablation group were significantly lower than those in the drug-treated group (two patients (4.2%) vs 17 patients (21.8%), P 0.001]. Cox multivariate analysis showed that the prevalence of atrial fibrillation (HR 9.082, 95% CI 1.130-73.011, P = 0.038) and previous history of heart failure (HR 2.860, 95% CI 1.072-7.633, P = 0.036) ) Was an independent risk factor for hospitalization for unplanned cardiovascular causes. Conclusions Sinus rhythm maintenance rate and unplanned cardiovascular hospitalization rate in patients undergoing HCM with atrial fibrillation were significantly better than those in the drug treatment group. The treatment strategies and history of prior heart failure were hospitalized for unplanned cardiovascular causes Independent risk factors.