房颤患者心脏射频消融联合左心耳封堵术后晚期复发危险因素研究

Risk Factors of Recurrence in Patients with Atrial Fibrillation after Cardica Radiofrequency Ablation Combined with Left Atrial Appendage Closure

摘要: 目的：分析心房颤动患者射频消融联合左心耳封堵术(一站式手术)术后房颤晚期复发的危险因素，为房颤患者开展临床及介入的诊疗方案决策提供参考意见及依据。方法：连续纳入2019年3月至2022年4月期间在青岛大学附属医院心血管内科病房住院行一站式手术的心房颤动患者共80人，根据术后半年内房颤是否复发分为复发组与非复发组，收集并比较两组患者术前的临床指标、心脏结构与功能学指标和血清学指标，进行回顾性研究，分析一站式术后房颤复发的相关危险因素。结果：共24例(30%)研究对象术后房颤复发，单因素分析表明，复发组房颤病程(t = 2.682, P = 0.012)、房颤性质(χ² = 17.654, P < 0.001)、早期复发率(χ² = 38.355, P < 0.001)、左心房前后径(LAD) (t = 4.883, P < 0.001)、总胆固醇(TC) (t = 2.491, P = 0.015)高于非复发组，复发组高血压比例(χ² = 12.444, P < 0.001)、CHA2DS2-VASc评分(t = −2.806, P = 0.008)、左心室射血分数(LVEF) (t = −2.093, P = 0.040)、血清脂蛋白a (t = −3.245, P = 0.002)水平低于非复发组，上述结果均具有统计学意义(P < 0.05)；Logistic回归分析提示，术前LAD (OR = 1.225, P = 0.013)是影响房颤患者一站式术后房颤复发的独立危险因素。结论：术前左心房前后径可在一定程度上评估行一站式手术的房颤患者术后房颤晚期复发风险。

Abstract: Objective: To analyze risk factors of recurrence of atrial fibrillation (AF) after radiofrequency ab-lation combined with left atrial appendage closure (one-stop surgery) in patients with atrial fi-brillation, and to provide reference and basis for the decision-making of clinical and interventional treatment. Methods: A total of 80 patients with atrial fibrillation who underwent one-stop surgery in the Department of Cardiology, Affiliated Hospital of Qingdao University from March 2019 to April 2022 were included, according to the recurrence of postoperative atrial fibrillation in half year they were divided into groups with and without recurrence, to collect and compare the two groups of patients with preoperative clinical index, cardiac structure, function index and serological indicator. A retrospective study was conducted to analyze the risk factors of atrial fibrillation recurrence after one-stop surgery. Results: A total of 24 patients (30%) had AF recurrence after operation. Univariate analysis showed that the duration of AF (t = 2.682, P = 0.012), the nature of AF (χ² = 17.654, P < 0.001) and the early recurrence rate (χ² = 38.355, P < 0.001), LAD (t = 4.883, P < 0.001) and TC (t = 2.491, P = 0.015) in the recurrence group were higher than those in the non-recurrence group. The proportion of hypertension (χ² = 12.444, P = 0.015), CHA2DS2-VASc score (t = −2.806, P = 0.008), left ventricular ejection fraction (LVEF) (t = −2.093, P = 0.040), serum lipoprotein a (t = −3.245, P = 0.002) in the recurrence group were lower than those in the non- recurrence group. The above results were statistically significant (P < 0.05). Logistic regression analysis showed that preoperative LAD (OR = 1.225, P = 0.013) was an independent risk factor for AF recurrence in patients with AF after one-stop surgery. Conclusion: The anterior and posterior diameter of left atrium before operation can be used to evaluate the risk of late recurrence of AF in patients with AF undergoing one-stop surgery.