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目的:左心房大小可以预测心房颤动(房颤)导管射频消融术后的复发。本研究旨在探讨右心房大小是否可以预测房颤射频消融术后复发。方法:纳入2009-01-2011-12在北京安贞医院行导管射频消融术的阵发性房颤患者共196例。阵发性房颤的消融策略为双侧环肺静脉隔离(PVI)。术后以常规心电图和动态心电图随访患者心律失常复发情况。运用回归分析方法甄别与心律失常复发相关的危险因素并检测其预测效力。结果:术后随访(25.3±18.1)个月,共有111例消融术后复发。右心房横径(RAD)和左心房内径(LAD,r=0.285,P<0.001),左心室射血分数(r=-0.241,P=0.001)和左心室舒张末期内径(r=0.239,P=0.001)有关。多因素Cox回归分析显示RAD可以独立预测房颤合并LAD增大患者术后复发(HR 1.044,95%CI1.007~1.082,P=0.021)。其中RAD的截断值为35.5 mm时的预测敏感性为85.4%,特异性为29.2%。KaplanMeier分析两组的窦性心律维持率有显著性差别(Log Rank P=0.034)。结论:右心房增大可以独立预测阵发性房颤合并左心房增大患者的房颤术后远期复发。推测双心房参与房颤的发生与维持。
Purpose: Left atrial size can predict recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation. This study aimed to investigate whether right atrial size can predict recurrence after atrial fibrillation radiofrequency ablation. METHODS: A total of 196 patients with paroxysmal atrial fibrillation undergoing catheter ablation at Beijing Anzhen Hospital from January 2009 to December 2011 were enrolled. Paroxysmal atrial fibrillation ablation strategy for bilateral circumferential pulmonary vein isolation (PVI). Postoperative patients with conventional electrocardiogram and ECG follow-up of arrhythmia recurrence. Regression analysis was used to identify the risk factors associated with the recurrence of arrhythmia and test its predictive power. Results: All the patients were followed up (25.3 ± 18.1) months after operation. A total of 111 patients recurred after ablation. Left ventricular ejection fraction (r = -0.241, P = 0.001) and left ventricular end diastolic diameter (r = 0.239, P = 0.001). Multivariate Cox regression analysis showed that RAD could independently predict postoperative recurrence in patients with atrial fibrillation and increased LAD (HR 1.044, 95% CI 1. 007 to 1.082, P = 0.021). The predictive sensitivity of RAD with a cutoff value of 35.5 mm was 85.4% and the specificity was 29.2%. KaplanMeier analysis of the two groups of sinus rhythm maintenance rates were significantly different (Log Rank P = 0.034). Conclusion: The increase of right atrium can independently predict the long-term recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation and left atrial enlargement. It is speculated that biparietal involvement in the occurrence and maintenance of atrial fibrillation.