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目的探讨抗心律失常药物对心房颤动(简称房颤)导管消融术后早期复发和晚期复发的影响。方法210例房颤患者在三维电解剖标测系统和肺静脉环状标测电极联合指导下行环肺静脉电隔离。术后应用抗心律失常药物3个月,其中服用普罗帕酮29例、胺碘酮113例、索他洛尔3例,未服用药物65例,因索他洛尔组病例数少仅对前三组进行分析。早期复发定义为导管消融3个月内发生快速性房性心律失常,晚期复发定义为导管消融3个月后停用抗心律失常药物后发生快速性房性心律失常。结果三组平均年龄具有显著差异,余基线资料无显著性差异。术后3个月内共88例(41.9%)出现早期复发,普罗帕酮、胺碘酮、未服用抗心律失常药物三组早期复发率分别为41.4%,32.7%,55.4%,具有显著差异(P=0.013)。Logistic分析显示胺碘酮与早期复发独立相关(比数比=0.37,95%可信区间0.19～0.72,P=0.003)。随访180±75(91～374)天,66例(31.4%)晚期复发,三组晚期复发率分别为34.5%,28.3%,32.3%,无显著差异(P=0.752)。Logistic分析显示抗心律失常药物不是晚期复发的独立危险因素(P=0.978)。服索他洛尔3例均出现早期复发和晚期复发。结论术后服用抗心律失常药物特别是胺碘酮可显著降低房颤导管消融的早期复发,但对晚期复发无影响。
Objective To investigate the effect of antiarrhythmic drugs on early recurrence and late recurrence after catheter ablation of atrial fibrillation (AF). Methods A total of 210 patients with atrial fibrillation were instructed to conduct the circumferential pulmonary vein isolation with 3D electroanatomic mapping system and pulmonary vein ring mapping electrode. Postoperative antiarrhythmic drugs for 3 months, of which 29 cases were taking propafenone, 113 cases of amiodarone, 3 cases of sotalol, 65 cases of non-taking drugs, Three groups for analysis. Early recurrence is defined as atrial tachyarrhythmia occurring within 3 months of catheter ablation, and late recurrence is defined as the onset of tachyarrhythmia after discontinuation of anti-arrhythmic drug 3 months after catheter ablation. Results The average age of the three groups have significant differences, the remaining baseline data no significant difference. Early recurrence occurred in 88 cases (41.9%) within 3 months after operation. The early recurrence rates of propafenone, amiodarone and antiarrhythmic drugs were 41.4%, 32.7% and 55.4% respectively, with significant differences (P = 0.013). Logistic analysis showed that amiodarone was independently associated with early recurrence (odds ratio = 0.37, 95% CI 0.19-0.72, P = 0.003). Followed up for 180 ± 75 (91 ~ 374) days and 66 cases (31.4%) had late recurrence. The late recurrence rates in the three groups were 34.5%, 28.3% and 32.3% respectively, with no significant difference (P = 0.752). Logistic analysis showed that antiarrhythmic drugs were not an independent risk factor for late relapse (P = 0.978). 3 cases of sotalol were early recurrence and late recurrence. Conclusions Postoperative antiarrhythmic drugs, especially amiodarone, can significantly reduce the early recurrence of atrial fibrillation catheter ablation, but have no effect on the late recurrence.