盐水灌注射频消融对心房颤动患者左房压力的影响以及术后发生高左房压的危险因素分析

马改改; 方理刚; 高鹏; 程中伟; 陈太波; 方全

doi:10.13201/j.issn.1001-1439.2020.06.016

盐水灌注射频消融对心房颤动患者左房压力的影响以及术后发生高左房压的危险因素分析

- 中国医学科学院北京协和医学院北京协和医院心内科(北京, 100730)

详细信息

通讯作者: 方全,E-mail:quanfangxjn2013@163.com

中图分类号: R541.75

收稿日期: 2019-10-29

修回日期: 2020-03-12

The changes in left atrial pressure after open-irrigated radiofrequency catheter ablation of atrial fibrillation and the risk factors of high left atrial pressure after ablation

- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China

More Information

Corresponding author: FANG Quan, E-mail: quanfangxjn2013@163.com

Received Date: 29 October 2019

Revised Date: 12 March 2020

摘要

摘要: 目的：比较心房颤动（房颤）患者经盐水灌注射频消融前后的左房压力（LAP）变化，分析盐水灌注射频消融对LAP的影响并探讨术后发生高LAP （LAP≥18 mmHg，1 mmHg=0.133 kPa）的危险因素。方法：连续纳入2017年5月-2017年9月住院行射频消融治疗的72例左室射血分数保留的房颤患者，分别在房间隔穿刺后即刻和消融结束撤出导管前测定LAP。采集患者一般临床资料和术前超声心动图参数，并记录术中盐水灌注量、液体总入量和手术时间。根据术后平均LAP将患者分为2组，高LAP组（LAP≥18 mmHg，16例）和LAP正常组（LAP<18 mmHg，56例）。结果：房颤患者消融前后LAP比较差异有统计学意义[（8.9±4.8） mmHg：（13.1±5.5） mmHg，P<0.001]。术后高LAP组年龄[（68±9）岁：（61±11）岁，P=0.035]、持续房颤比例（50.0%：23.2%，P=0.038）、左房容积指数[（41.43±11.85） ml/m²：（34.83±9.63） ml/m²，P=0.030]、BNP水平[（183.5（71.5，363.5） ng/L：90.0（39.0，137.0） ng/L，P=0.043]均显著高于LAP正常组。多因素Logistic回归分析显示年龄（OR=1.117，95%CI：1.023~1.220，P=0.014）和持续房颤（OR=6.424，95%CI：1.370~30.133，P=0.018）是术后发生高LAP的独立危险因素。结论：房颤患者经盐水灌注射频消融后LAP显著增加，高龄、持续房颤的患者术后发生高LAP的风险显著增加，需警惕术后早期急性心力衰竭的发生。
- 心房颤动 /
- 射频消融 /
- 盐水灌注 /
- 左房压力
Abstract: Objective: To evaluate the changes in left atrial pressure (LAP) after open-irrigated radiofrequency catheter ablation of atrial fibrillation (AF) and the risk factors of high LAP after ablation.Method: A total of 72 consecutive AF patients with preserved left ventricular ejection fraction admitted into our department to receive irrigated radiofrequency ablation from May 2017 to Sep 2017 were included and LAP was measured via transseptal sheath at the beginning and end of ablation procedures.We prospectively analyzed the clinical data, echocardiographic parameters, catheter irrigation and total volume load during ablation procedure, procedure duration.According to mean LAP after ablation, they were divided into two groups of high LAP (mean LAP ≥ 18 mmHg, n=16) and normal LAP (mean LAP<18 mmHg, n=56).Result: Mean LAP significantly increased after ablation[(8.9±4.8) mmHg:(13.1±5.5) mmHg, P<0.001].Age[(68±9) years:(61±11) years, P=0.035], proportion of persistent AF (50.0%:23.2%, P=0.038), left atrial volume index[(41.43±11.85) ml/m²:(34.83±9.63) ml/m², P=0.030], and BNP level[(183.5(71.5, 363.5) ng/L:90.0(39.0, 137.0) ng/L, P=0.043] were significantly higher in the high LAP group than in the normal LAP group.Multivariate logistic regression analysis revealed that age (OR=1.117, 95%CI:1.023~1.220, P=0.014) and persistent AF (OR=6.424, 95%CI:1.370~30.133, P=0.018) were independently correlated with the occurrence of high LAP after ablation.Conclusion: LAP significantly increased after open-irrigated radiofrequency ablation of AF.Older patients with persistent AF had a higher risk of high LAP after ablation.
- atrial fibrillation /
- radiofrequency catheter ablation /
- open irrigation /
- left atrial pressure

HTML全文

参考文献(20)

[1]	January CT, Wann LS, Calkins H, et al.2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol, 2019, 74(1):104-132.
[2]	Calkins H, Hindricks G, Cappato R, et al.2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J].Heart Rhythm, 2017, 14(10):e275-e444.
[3]	Kirchhof P, Benussi S, Kotecha D, et al.2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS[J].Rev Esp Cardiol (Engl Ed), 2017, 70(1):50.
[4]	马长生.2019年心房颤动治疗新进展[J].临床心血管病杂志, 2019, 35(11):967-971.
[5]	Gibson DN, Di Biase L, Mohanty P, et al.Stiff left atrial syndrome after catheter ablation for atrial fibrillation:clinical characterization, prevalence, and predictors[J].Heart Rhythm, 2011, 8(9):1364-1371.
[6]	Steel KE, Roman-Gonzalez J, O'Bryan CT.Images in cardiovascular medicine.Severe left atrial edema and heart failure after atrial fibrillation ablation[J].Circulation, 2006, 113(12):e659.
[7]	Yang Y, Liu Q, Wu Z, et al.Stiff Left Atrial Syndrome:A Complication Undergoing Radiofrequency Catheter Ablation for Atrial Fibrillation[J].J Cardiovasc Electrophysiol, 2016, 27(7):884-889.
[8]	Park J, Yang PS, Kim TH, et al.Low Left Atrial Compliance Contributes to the Clinical Recurrence of Atrial Fibrillation after Catheter Ablation in Patients with Structurally and Functionally Normal Heart[J].PLoS One, 2015, 10(12):e143853.
[9]	Weber R, Minners J, Restle C, et al.Pulmonary edema after extensive radiofrequency ablation for atrial fibrillation[J].J Cardiovasc Electrophysiol, 2008, 19(7):748-752.
[10]	Verma I, Tripathi H, Sikachi RR, et al.Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation:The Lungs, the Atrium or the Ventricle?[J].Heart Lung Circ, 2016, 25(12):1177-1183.
[11]	Park JW, Yu HT, Kim TH, et al.Atrial Fibrillation Catheter Ablation Increases the Left Atrial Pressure[J].Circ Arrhythm Electrophysiol, 2019, 12(4):e7073.
[12]	Bergau L, Vollmann D, Luthje L, et al.Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation[J].Indian Pacing Electrophysiol J, 2014, 14(4):181-193.
[13]	Seiler J, Steven D, Roberts-Thomson KC, et al.The effect of open-irrigated radiofrequency catheter ablation of atrial fibrillation on left atrial pressure and B-type natriuretic peptide[J].Pacing Clin Electrophysiol, 2014, 37(5):616-623.
[14]	Witt CM, Fenstad ER, Cha YM, et al.Increase in pulmonary arterial pressure after atrial fibrillation ablation:incidence and associated findings[J].J Interv Card Electrophysiol, 2014, 40(1):47-52.
[15]	Reddy Y, El SA, Packer D, et al.Evaluation of shortness of breath after atrial fibrillation ablation-Is there a stiff left atrium?[J].Heart Rhythm, 2018, 15(6):930-935.
[16]	Pacold I, Hwang MH, Palac RT, et al.The effects of rapid volume expansion on the right and left cardiac filling pressures after coronary artery bypass surgery[J].Chest, 1988, 93(6):1144-1147.
[17]	Wylie JJ, Peters DC, Essebag V, et al.Left atrial function and scar after catheter ablation of atrial fibrillation[J].Heart Rhythm, 2008, 5(5):656-662.
[18]	Cochet H, Mouries A, Nivet H, et al.Age, atrial fibrillation, and structural heart disease are the main determinants of left atrial fibrosis detected by delayed-enhanced magnetic resonance imaging in a general cardiology population[J].J Cardiovasc Electrophysiol, 2015, 26(5):484-492.
[19]	杨廷杰, 张菲斐.心房颤动射频消融术后左心房球形度预测复发的价值[J].临床心血管病杂志, 2018, 34(10):1006-1010.
[20]	张宇祯, 张其银, 惠杰, 等.左房主动排空分数对阵发性心房颤动射频消融术后复发机制的预判价值[J].临床心血管病杂志, 2019, 35(3):215-220.