本文關(guān)鍵詞：冠狀靜脈竇頻率特點與持續(xù)性心房顫動導管消融術(shù)預后關(guān)系的臨床研究　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 持續(xù)性心房顫動 射頻消融術(shù) 冠狀竇 肺靜脈電隔離

【摘要】：背景:冠狀靜脈竇(冠狀竇)位于心臟的左后部冠狀溝內(nèi),其結(jié)構(gòu)有利于不穩(wěn)定微小折返環(huán)形成,從而與心房顫動(房顫)的觸發(fā)有重要聯(lián)系。房顫的導管消融過程中,針對此關(guān)鍵結(jié)構(gòu)的干預可終止房顫。本研究的目的在于探究冠狀竇頻率是否與房顫的觸發(fā)和維持及房顫導管消融術(shù)預后相關(guān)。方法:本回顧性研究共入組122例持續(xù)性房顫患者,所有患者均為癥狀性、藥物難治性房顫,且首次接受房顫射頻消融術(shù)治療�；颊咴谛猩漕l消融術(shù)前,首先通過環(huán)狀標測導管獲得心房內(nèi)多部位心內(nèi)電圖。持續(xù)性房顫患者的消融術(shù)式均采用統(tǒng)一的類似遞進式消融術(shù)式。術(shù)后3個月內(nèi)設(shè)為空白期。消融術(shù)后的3、6、9和12個月門診行相關(guān)檢查,評估導管消融治療效果,1年后每6個月來門診隨診1次。在隨訪期間,要接受包括問卷、24小時動態(tài)心電圖,12導體表心電圖等相關(guān)檢查,用于評估患者是否有癥狀或復發(fā)。復發(fā)的患者的手術(shù)策略與第一次相同。手術(shù)成功的標準為在隨訪期間無心房顫動或其他持續(xù)性房性心律失常發(fā)生。結(jié)果:122例患者中12例(9.8%)在行肺靜脈隔離后,心律由房顫轉(zhuǎn)為竇性心律;其余110例繼續(xù)行遞進式消融,其中22例(18%)患者,在逐步消融過程中房顫終止。其中1例患者在行左房頂部消融時房顫終止,3例在行右上肺靜脈前庭部位碎裂電位消融時房顫終止,1例在行左心耳基底部碎裂電位消融時房顫終止,2例在消融房間隔碎裂電位時房顫終止,15例患者在行冠狀竇心內(nèi)膜面消融時房顫終止。除外PVI終止的12例患者,余110例患者,依據(jù)消融過程中終止與否分為終止組與未終止組。終止組(22例患者)與未終止組(88例患者)相比較,終止的22例患者其冠狀竇近端頻率相對較快(10.2 ± 2.1 Hz和8.3 ± 1.8 Hz,P0.001),且終止的22例持續(xù)性房顫患者的冠狀竇遠端頻率與近端頻率比值相對較小(56.6±10.11%和70.7±9.8%,P0.001)。應(yīng)用受試者工作特征曲線分析得出:冠狀竇遠端與近端頻率比值67%預測房顫終止的陽性率為53%(敏感度為86%,特異度為67%,陰性預測值為95%)。終止組冠狀竇遠端與近端頻率比值cut off值67%預測房顫終止的曲線下面積為0.842(95%可信區(qū)間為0.749-0.936;P0.001)。第1次術(shù)后復發(fā)48例患者,其中43例患者接受再次手術(shù),6例患者接受三次手術(shù)。第一次術(shù)后,冠狀竇遠端頻率與近端頻率的比值67%的患者與比值≥67%的患者兩組的成功率分別為69%和48%(p=0.032)。在經(jīng)歷平均1.4±0.6次手術(shù)和平均46±18個月的隨訪后,冠狀竇遠端頻率與近端頻率的比值67%的患者與比值≥67%的患者兩組的成功率分別為90%和74%(p=0.042)。通過Logistic回歸分析得出冠狀竇遠端與近端頻率的比值是持續(xù)性房顫患者導管消融術(shù)預后的獨立預測因子(OR 值 1.131,95%可信區(qū)間 1.053-1.214;p=0.001)。隨訪 46±18月后,研究顯示冠狀竇遠端與近端頻率的比值67%的患者其單次房顫消融術(shù)的預后及多次導管消融的長期預后均優(yōu)于比值≥67%的患者。結(jié)論:1.冠狀竇近端快速的電活動可能對持續(xù)性房顫的維持起重要作用。2.冠狀竇遠端與近端頻率比值可能是消融術(shù)中房顫終止及患者遠期預后的獨立預測因素。3.冠狀竇遠端與近端頻率比值67%的持續(xù)性房顫患者能從冠狀竇心內(nèi)膜消融中獲益更多,可能這部分患者更適合接受冠狀竇心內(nèi)膜消融。
[Abstract]:Background: the coronary sinus (CS) located in the heart of the rear left coronary sulcus, its structure is conducive to unstable micro reentrant formation, and atrial fibrillation (AF) is an important trigger. Catheter ablation of atrial fibrillation in the process of the key structure of the intervention may terminate atrial fibrillation. This study the purpose is to explore whether the frequency of coronary sinus and atrial fibrillation trigger atrial fibrillation ablation and maintain and prognosis. Methods: a retrospective study in a cohort of 122 patients with persistent atrial fibrillation patients, all patients were symptomatic, drug refractory atrial fibrillation, and the first time to accept atrial fibrillation radiofrequency ablation therapy. The patients in the radiofrequency ablation, first through the circular mapping catheter for multi site atrial endocardial electrogram ablation in patients with atrial fibrillation. The last are used like the progressive ablation of unity. Within 3 months after surgery for blank ablation after 3, 6,9 and 12 months for outpatient examination, evaluation of catheter ablation treatment, 1 years after every 6 months to outpatient follow-up 1 times. During the follow-up period, to accept the questionnaires, 24 hour dynamic electrocardiogram, 12 lead ECGs and related inspection, to assess whether patients have symptoms or recurrent patients. Surgical strategy for the first time. And the recurrence of the same standard for successful surgery during the follow-up period without atrial fibrillation or persistent atrial arrhythmia. Results: 122 patients in 12 cases (9.8%) in pulmonary vein isolation after cardiac by atrial fibrillation to sinus rhythm; the remaining 110 cases underwent progressive type of ablation, including 22 cases (18%) patients in the ablation process gradually terminate atrial fibrillation. Among them, 1 cases of left atrial ablation of atrial fibrillation in patients with top termination, termination of 3 patients of right upper pulmonary vein antrum CFAEs ablation of atrial fibrillation, 1 cases of left atrial appendage at the base of potential Ablation of atrial fibrillation termination, termination of 2 cases of atrial septal ablation in CFAEs when AF terminated in 15 patients of coronary sinus endocardial surface ablation of atrial fibrillation. Except 12 cases of PVI termination patients, 110 cases, on the basis of the ablation process termination and divided into end group and non group. The final termination check group (22 patients) and non termination group (88 patients) compared to 22 cases of patients with coronary sinus proximal end frequency is relatively fast (10.2 + 2.1 + 1.8 Hz and 8.3 Hz, P0.001), distal coronary sinus frequency and termination of 22 cases of persistent atrial fibrillation in patients with proximal frequency the ratio of the smaller (56.6 + 10.11% and 70.7 + 9.8%, P0.001). The receiver operating characteristic curve analysis: application of distal coronary sinus and proximal frequency ratio of the 67% predicted positive rate of AF termination was 53% (sensitivity was 86%, specificity was 67%, the negative predictive value was 95%). Termination group the proximal and distal coronary sinus frequency ratio The value of cut off value of 67% AF termination forecast area under the curve was 0.842 (95% Ci, 0.749-0.936; P0.001). Postoperative recurrence in first patients with 48 cases, of which 43 patients underwent reoperation, 6 patients underwent surgery three times. After the first operation, two groups of patients and the success ratio was larger than 67% the proximal and distal coronary sinus frequency frequency ratio of 67% patients was respectively 69% and 48% (p=0.032). After an average of 1.4 + 0.6 and 46 + times operation average 18 months follow-up, the success of the two groups of patients with coronary ratio was larger than 67% Dou Yuanduan frequency and the proximal frequency ratio of 67%. Patients were 90% and 74% (p=0.042). Through Logistic regression analysis showed that the ratio of coronary Dou Yuanduan and proximal frequency are independent predictors of persistent atrial fibrillation ablation catheter patients prognosis (OR = 1.131,95% CI 1.053-1.214; p=0.001). Follow up of 46 + 18 months after study The long-term prognosis in coronary sinus distal and proximal frequency ratio of 67% patients with single atrial fibrillation ablation and the prognosis of multiple catheter ablation were better than the ratio was larger than 67% of the patients. Conclusion: the electrical activity of 1. coronary sinus proximal fast of persistent atrial fibrillation plays an important role in the maintenance of.2. and proximal coronary Dou Yuanduan frequency the ratio may be independent predictors of.3. in patients with distal coronary sinus catheter ablation of atrial fibrillation termination and long-term prognosis of patients with proximal frequency ratio of 67% persistent atrial fibrillation can benefit more from the coronary sinus endocardial ablation, may be more suitable for this part of the patients undergoing coronary sinus endocardial ablation.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.75

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