【摘要】：背景:導(dǎo)管射頻消融是治療心房顫動(dòng)(以下簡(jiǎn)稱(chēng)房顫)的有效方法之一,在房顫導(dǎo)管消融術(shù)后短期內(nèi)房性心律失常的發(fā)生率可能增加,因此針對(duì)這一特殊時(shí)期,將其定義為房顫消融后空白期,一些患者在空白期內(nèi)復(fù)發(fā)房顫、房速等房性心律失常時(shí),會(huì)出現(xiàn)房顫/房速終止后長(zhǎng)間歇,稱(chēng)為空白期快慢綜合征,但其預(yù)后和治療策略目前尚無(wú)相關(guān)報(bào)道。目的:本文旨在觀(guān)察陣發(fā)性房顫消融術(shù)后空白期快慢綜合征發(fā)生率、臨床特點(diǎn)、治療及預(yù)后等。方法:觀(guān)察2002年1月至2016年6月大連醫(yī)科大學(xué)附屬第一醫(yī)院陣發(fā)性房顫消融術(shù)后患者,選取空白期出現(xiàn)快慢綜合征30例患者(A組)。此外,隨機(jī)選取同期入院接受房顫導(dǎo)管消融且空白期復(fù)發(fā)房性快速性心律失常但無(wú)長(zhǎng)間歇的患者60例作為B組,另隨機(jī)選取同期入院接受房顫導(dǎo)管消融且無(wú)空白期復(fù)發(fā)的陣發(fā)性房顫消融患者60例作為C組。統(tǒng)計(jì)這些患者性別、年齡、基礎(chǔ)疾病等,對(duì)患者進(jìn)行隨訪(fǎng),觀(guān)察其治療、預(yù)后,比較三組之間消融前后HRV的差異等。結(jié)果:(1)2002年1月至2016年6月期間大連醫(yī)科大學(xué)附屬第一醫(yī)院共行房顫導(dǎo)管消融1619例,空白期出現(xiàn)快慢綜合征30例(發(fā)生率1.9%)。(2)三組患者之間年齡、性別、基礎(chǔ)疾病等基線(xiàn)特征均無(wú)明顯差異(P0.05)。(3)在三組中,患者消融術(shù)后HRV各項(xiàng)參數(shù)較術(shù)前相比均降低,但A組中各HRV指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),在B組中只有SDNN、SDANN有顯著性差異(P0.05),C組中,HRV各指標(biāo)均有統(tǒng)計(jì)學(xué)意義(P0.05)(4)A組與B組射頻消融術(shù)后HRV等比較,SDNN、SDANN等少部分有統(tǒng)計(jì)學(xué)差異(P0.05);A組與C組射頻消融術(shù)后HRV等比較,有明顯統(tǒng)計(jì)學(xué)差異(P0.05)(5)本次入選空白期快慢綜合征患者30例,根據(jù)患者意愿,接受導(dǎo)管消融、起搏器植入、觀(guān)察。平均隨訪(fǎng)36.9±23.9個(gè)月,A組12例患者(40%)進(jìn)行了再次導(dǎo)管消融(8例為空白期內(nèi)消融,4例為空白期后消融),其中10例患者無(wú)房顫或長(zhǎng)間歇,2例患者再次術(shù)后仍有房顫發(fā)作,但無(wú)長(zhǎng)間歇;A組3例患者(10%)空白期植入永久性起搏器。15例患者(50%)藥物等治療(隨訪(fǎng)期內(nèi)12例患者無(wú)房顫等房性心律失常復(fù)發(fā),3例患者雖仍有房顫復(fù)發(fā),但無(wú)RR長(zhǎng)間歇)。結(jié)論:(1)陣發(fā)性房顫導(dǎo)管消融術(shù)后空白期快慢綜合征發(fā)生率為1.9%,可能與神經(jīng)失衡、迷走神經(jīng)活躍有關(guān)。(2)對(duì)于此類(lèi)患者,大多數(shù)預(yù)后呈良性,病情呈可逆性。
[Abstract]:Background: radiofrequency catheter ablation is one of the effective methods for the treatment of atrial fibrillation (AF). The incidence of atrial arrhythmias may increase in the short term after atrial fibrillation catheter ablation. It is defined as the blank period after atrial fibrillation ablation. When atrial fibrillation and atrial tachycardia occur in some patients with atrial fibrillation or atrial tachycardia, long intervals after atrial fibrillation / atrial tachycardia terminates, which are called blank period fast and slow syndrome, are found in some patients with atrial fibrillation and atrial tachycardia. However, the prognosis and treatment strategies have not been reported. Objective: to observe the incidence, clinical features, treatment and prognosis of blank fast and slow syndrome after paroxysmal atrial fibrillation ablation. Methods: after paroxysmal atrial fibrillation ablation in the first affiliated Hospital of Dalian Medical University from January 2002 to June 2016, 30 patients with fast and slow syndrome (group A) were selected. In addition, 60 patients with recurrent atrial tachyarrhythmia who were admitted to hospital at the same time and received atrial fibrillation catheter ablation without long interval were randomly selected as group B. In addition, 60 patients with paroxysmal atrial fibrillation (PAF) who were admitted to hospital at the same time and received catheter ablation without recurrence were randomly selected as group C. The sex, age and underlying diseases of these patients were counted. The patients were followed up, the treatment and prognosis were observed, and the differences of HRV before and after ablation were compared among the three groups. Results: (1) from January 2002 to June 2016, 1619 cases of atrial fibrillation catheter ablation were performed in the first affiliated Hospital of Dalian Medical University. 30 cases (1.9%). (_ 2) with rapid onset syndrome occurred in blank period. There was no significant difference in baseline characteristics of basic diseases (P0.05). (3) in the three groups, the parameters of HRV after ablation were all decreased compared with those before operation, but there was no statistical difference in each HRV index in group A (P0.05). Only SDNN,SDANN had significant difference in group B (P0.05), C group, all the indexes of HRV were statistically significant (P0.05) (4) HRV et al. After radiofrequency ablation in group A and group B, SDNN, etc. There were significant differences in SDANN and other parts (P0.05). There was significant difference in HRV between group A and group C after radiofrequency ablation (P0.05) (5) 30 patients with blank fast and slow syndrome were enrolled in this study. According to the wishes of the patients, catheter ablation, pacemaker implantation and observation were performed. After an average follow-up of 36.9 鹵23.9 months, 12 patients (40%) in group A underwent re-catheter ablation (8 cases in blank period and 4 cases in post-blank period), 10 of whom had no atrial fibrillation or long interval. Atrial fibrillation occurred again in 2 patients, but there was no long interval. In group A, permanent pacemaker implantation was performed in 3 patients (10%) and drug therapy in 15 patients (50%) (12 patients had no recurrence of atrial fibrillation and 3 patients still had atrial fibrillation recurrence, but no long interval of RR). Conclusion: (1) the incidence of blank fast and slow syndrome after paroxysmal atrial fibrillation catheter ablation is 1.9, which may be related to nerve imbalance and vagal nerve activity. (2) for most of these patients, the prognosis is benign and the disease is reversible.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.75

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