导管射频消融术对心力衰竭合并持续性心房颤动患者心脏结构与远期预后的影响

李祺; 罗贵全; 刘磊; 谭震; 任宏强

doi:10.16766/j.cnki.issn.1674-4152.003873

导管射频消融术对心力衰竭合并持续性心房颤动患者心脏结构与远期预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.003873

遂宁市中心医院房颤中心，四川遂宁 629000

基金项目:

四川省科技厅计划项目 2019YFS0345

详细信息

通讯作者:
任宏强，E-mail：rhq1980@163.com

中图分类号: R541.6 R541.75
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- 文章访问数: 9
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- 被引次数: 0
出版历程
- 收稿日期: 2024-02-11
- 网络出版日期: 2025-03-27

The effect of catheter radiofrequency ablation on cardiac structure and long-term prognosis in patients with heart failure and persistent atrial fibrillation

Atrial Fibrillation Center, Suining Central Hospital, Suining, Sichuan 629000, China

摘要

摘要: 目的分析心力衰竭合并持续性房颤(AF)患者行导管射频消融术(RFA)后左心结构与射血分数的变化, 并探讨RFA对生存预后的影响。方法回顾性分析2017年1月-2019年5月于遂宁市中心医院房颤中心住院治疗的心力衰竭合并持续性AF患者共379例, 根据住院期间是否行RFA分组, 进一步通过倾向评分匹配并结合纳入排除标准最终确定为射频组33例与对照组126例, 比较2组基线资料。对所有患者进行随访, 比较住院期间与随访期间的部分超声心动图指标并评估心脏结构改善情况。采用Kaplan-meier生存分析评估射频组与对照组的远期生存情况。通过多因素Cox回归分析校正混杂因素并评估RFA对远期预后的影响。结果射频组与对照组基线资料比较结果显示2组具有可比性。与入院时比较, 射频组在随访期间复查超声心动图指标中左室舒张末内径和左室射血分数有改善, 差异有统计学意义(P < 0.05)。中位随访时间28个月中, 射频组中4例(12.1%)和对照组中39例(31.0%)达到随访终点事件。Kaplan-meier生存分析显示射频组比对照组的远期预后更好(P=0.049)。通过多因素Cox回归校正性别、年龄、体重指数、左室射血分数与心律转复除颤器植入, 结果显示RFA依然是远期预后的独立影响因子(HR=0.335, 95%CI: 0.116-0.964, P=0.043)。结论 RFA可以改善心力衰竭合并持续性AF的患者左心结构和射血分数, 是提升预后的重要因素。
- 导管射频消融 /
- 心房颤动 /
- 心力衰竭
Abstract: Objective To investigate the impact of catheter radiofrequency ablation (RFA) on cardiac structure and long-term survival in patients with heart failure and persistent atrial fibrillation (AF). Methods A retrospective analysis was conducted on 379 patients with heart failure and persistent AF who were hospitalized in the Atrial Fibrillation Center of Suining Central Hospital from January 2017 to May 2019.Based on whether they underwent RFA during their hospitalization, they were further divided into two groups: the RFA group (n=33) and the control group (n=126).The baseline data of both groups were compared.All patients were followed up, and some echocardiographic indicators were compared during hospitalization and follow-up to assess the improvement of cardiac structure.Kaplan-meier survival analysis was used to evaluate the long-term survival of the RFA group and the control group.Multivariate Cox regression analysis was used to correct for confounding factors and assess the impact of RFA on long-term prognosis. Results The baseline data of the RFA group and the control group showed comparable results.Compared with admission, the left ventricular end-diastolic diameter and left ventricular ejection fraction in the echocardiographic indicators of the RFA group improved significantly during follow-up, with statistically significant differences (P < 0.05).Among the 4 patients in the RFA group (12.1%) and 39 patients in the control group (31.0%), events occurred at the end of follow-up.Kaplan-meier survival analysis showed that the long-term prognosis of theRFA group was better than that of the control group (P=0.049).Through multivariate Cox regression analysis, adjusting for gender, age, body mass index, left ventricular ejection fraction, and implantable cardioverter defibrillator, it was found that RFA remained an independent factor affecting long-term prognosis (HR=0.335, 95%CI: 0.116-0.964, P=0.043). Conclusion RFA can improve the left ventricular structure and ejection fraction in patients with heart failure andpersistent AF, and is an important factor in improving prognosis.
- Catheter radiofrequency ablation /
- Atrial fibrillation /
- Heart failure

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图 1 2组心力衰竭合并持续性AF患者Kaplan-Meier生存分析

Figure 1. Kaplan-Meier survival analysis of 2 groups of patients with heart failure combined with persistent AF

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表 1 倾向性评分匹配后射频组与对照组心力衰竭合并持续性AF患者基线资料比较

Table 1. Comparison of baseline data between the radiofrequency group and the control group after propensity score matching

项目	对照组(n=126)	射频组(n=33)	统计量	P值
性别(男/女，例)	54/72	21/12	4.531^a	0.053
年龄[M(P₂₅, P₇₅), 岁]	67.0(58.0, 72.8)	66.0(59.0, 72.0)	0.041^b	0.968
BMI[M(P₂₅, P₇₅)]	24.1(22.5, 26.8)	24.2(21.5, 25.4)	1.261^b	0.207
高血压病[例(%)]	75(59.5)	18(54.5)	0.267^a	0.750
2型糖尿病[例(%)]	18(14.3)	5(15.2)	0.016^a	0.999
高脂血症[例(%)]	26(20.6)	7(21.2)	0.005^a	0.942
β受体阻滞剂[例(%)]	118(93.7)	31(93.9)	0.004^a	0.952
ACEI/ARB[例(%)]	84(66.7)	22(66.7)	0.001^a	0.999
ARNI[例(%)]	35(27.8)	12(36.4)	0.926^a	0.455
促甲状腺激素[M(P₂₅, P₇₅), mIU/L]	1.98(1.34, 2.58)	2.19(1.29, 4.25)	-1.140^b	0.254
血清白蛋白(x±s, g/L)	41.8±3.3	40.7±4.0	1.572^c	0.152
血清肌酐[M(P₂₅, P₇₅), μmoI/L]	72.8(58.1, 84.0)	69.2(53.2, 77.0)	1.563^b	0.118
出院前B型钠尿肽[M(P₂₅, P₇₅), pmol/L]	182(135, 222)	176(123, 221)	0.688^b	0.491
左房内径(x±s，mm)	40.90±6.29	40.40±6.79	0.415^c	0.693
左室舒张末内径[M(P₂₅, P₇₅), mm]	57.0(54.0, 59.0)	56.0(54.0, 58.0)	1.009^b	0.311
左室射血分数[M(P₂₅, P₇₅), %]	41.3(38.4, 43.6)	40.3(38.8, 44.0)	0.208^b	0.975
中/重度二尖瓣反流[例(%)]	29(23.0)	7(21.2)	0.049^a	0.826
完全性左束支传导阻滞[例(%)]	15(11.9)	2(6.1)	0.935^a	0.333
完全性右束支传导阻滞[例(%)]	16(12.7)	3(9.1)	0.323^a	0.570
心律转复除颤器植入[例(%)]	7(5.6)	2(6.1)	0.045^a	0.915
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 2组超声心动图心脏结构与功能指标比较(x±s，mm)

Table 2. Comparison of cardiac structure and function indexes by echocardiography in 2 groups(x±s, mm)

组别	例数	左房内径(mm)		t值	P值	左室舒张末内径(mm)		t值	P值	左室射血分数(%)		t值	P值
组别	例数	住院时	随访时	t值	P值	住院时	随访时	t值	P值	住院时	随访时	t值	P值
射频组	33	40.4±6.8	39.2±4.9	2.696	0.011	55.9±3.5	52.3±3.3	5.193	< 0.001	40.9±3.8	43.8±2.5	3.258	0.003
对照组	126	40.9±6.3	41.9±4.2	8.889	0.020	56.3±4.5	55.7±3.3	7.002	0.123	40.9±3.9	40.7±3.0	0.392	0.696
统计量		0.397^a	2.429^b			0.643^a	4.415^b			0.031^a	4.876^b
P值		0.693	0.015			0.523	< 0.001			0.975	< 0.001
注：^a为t值，^b为F值。

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表 3 RFA对心力衰竭合并持续性AF患者远期预后影响的多因素Cox回归分析

Table 3. Multivariate Cox regression analysis of the effect of RFA on the long-term prognosis of patients with heart failure complicated with persistent AF

变量	B	SE	Waldχ²	P值	HR(95% CI)
RFA	-1.094	0.540	4.109	0.043	0.335(0.116~0.964)
男性	-0.338	0.316	1.143	0.285	0.713(0.384~0.326)
年龄	0.008	0.017	0.236	0.627	1.008(0.975~1.042)
BMI	-0.037	0.044	0.694	0.405	0.964(0.884~1.051)
左室射血分数	0.082	0.043	3.568	0.059	1.085(0.997~1.181)
心律转复除颤器植入	0.018	0.617	0.001	0.976	1.018(0.304~3.416)

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