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目的研究不同类型的年轻心房颤动(房颤)患者(阵发性房颤、持续性房颤和持久的持续性房颤)导管消融治疗成功率和安全性。方法收集广东省心血管病研究所年龄<45岁,诊断为房颤并接受导管消融治疗的132例患者的临床、电生理及随访资料,应用COX比例风险模型分析初次消融和重复消融后复发的预测因子。结果患者年龄(38.0±5.6)岁,男101例,女31例,既往房颤病程2.05年;阵发性房颤91例,非阵发性房颤包括持续性房颤15例和持久的持续性房颤26例。初次消融后随访24.2个月,阵发性、持续性、持久的持续性房颤成功率分别为86.8%(79例)、66.7%(10例)、57.7%(15例),总体成功率78.8%。复发的患者有20例(71.4%)再次消融,随访14.3月,12例(75%)维持窦性心律。阵发性、持续性、持久的持续性房颤经过重复消融后窦性心律维持率分别为93.4%(85例)、86.7%(13例)、73.1%(19例),总体成功率88.6%。COX回归分析提示,初次消融后复发的预测因子分别是非阵发性房颤(HR=3.393,P=0.004)、左心房扩大(HR=1.066,P=0.004)、高血压病史(HR=4.203,P=0.006)和甲状腺疾病史(HR=5.280,P=0.001);重复消融后复发的预测因子则为右心房扩大(HR=1.133,P<0.001)和甲状腺疾病(HR=6.942,P=0.003)。无影响预后的严重并发症。结论年轻的房颤患者导管消融安全性好,成功率高。早期对年轻房颤患者进行消融治疗是合理的,但应注意心房扩大及甲状腺疾病对成功率的影响。
Objective To study the success and safety of catheter ablation in different types of patients with atrial fibrillation (paroxysmal atrial fibrillation, persistent atrial fibrillation and persistent persistent atrial fibrillation). Methods The clinical, electrophysiological and follow-up data of 132 patients who were diagnosed as atrial fibrillation undergoing catheter ablation and were collected at the Institute of Cardiovascular Disease of Guangdong Province were collected. The COX proportional hazards model was used to analyze the recurrence after primary ablation and repeated ablation Predictors. Results The age of patients (38.0 ± 5.6) years was 101 males and 31 females, with a history of atrial fibrillation of 2.05 years, 91 cases of paroxysmal atrial fibrillation, and 15 cases of non-paroxysmal atrial fibrillation including persistent atrial fibrillation Atrial fibrillation in 26 cases. The success rate of paroxysmal, persistent and sustained persistent atrial fibrillation were 86.8% (79 cases), 66.7% (10 cases) and 57.7% (15 cases), respectively. The overall success rate was 78.8 %. Twenty patients (71.4%) recurred abruptly again. After 14.3 months of follow-up, 12 patients (75%) maintained sinus rhythm. The rates of maintenance of sinus rhythm after repeated ablation of paroxysmal, persistent and persistent persistent atrial fibrillation were 93.4% (85 cases), 86.7% (13 cases) and 73.1% (19 cases), respectively. The overall success rate was 88.6% . COX regression analysis showed that the predictors of recurrence after initial ablation were non-paroxysmal atrial fibrillation (HR = 3.393, P = 0.004), left atrium enlargement (HR = 1.066, P = 0.004) (HR = 5.280, P = 0.001). The predictors of recurrence after repeat ablation were right atrium enlargement (HR = 1.133, P <0.001) and thyroid disease (HR = 6.942, P = 0.003) ). No serious effect on the prognosis of complications. Conclusion Young patients with atrial fibrillation catheter ablation safety, high success rate. Early ablation of young patients with atrial fibrillation is reasonable, but should pay attention to the impact of atrial enlargement and thyroid disease on the success rate.