Correlation between the diagnosis-to-ablation time and the recurrence after atrial fibrillation ablation
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摘要: 目的 通过回顾性分析心房颤动(房颤)患者诊断到消融时间(DAT)与术后复发的相关性，探讨房颤患者诊断到消融的最佳时间。 方法 选取2017年1月—2022年1月于我院首次行射频消融术的房颤患者，出院后定期通过门诊或电话对其进行随访。针对术后复发的影响因素采用多因素logistic回归分析法；Kaplan-Meier生存曲线用于对房颤消融术后未复发率进行分析。 结果 共纳入553例房颤患者，其中持续性房颤占37.1%，女性占44.3%，年龄为(62.3±10.21)岁，DAT为12(3，48)个月，术后随访(26.7±16.36)个月，房颤消融术后总体未复发率为80.3%。logistic回归分析显示，DAT(OR=1.005，95%CI：1.0~1.011，P＜0.05)、持续性房颤(OR=1.952，95%CI：1.160~3.385，P＜0.05)和女性是术后复发的独立危险因素。Kaplan-Meier生存分析表明，房颤伴DAT≤12个月的患者消融术后未复发率明显高于DAT>12个月的患者(84.8% vs.75.7%，P＜0.05)，持续性房颤患者消融术后未复发率明显低于阵发性房颤患者(76.1% vs.82.8%，P＜0.05)，而房颤患者男女间消融术后未复发率差别无统计学意义。按照DAT每间隔6个月分成0~6个月组、6~12个月组和>12个月组：阵发性房颤患者3组间消融术后累积未复发率差异有统计学意义(P＜0.05)，DAT 0~6个月组和DAT 6~12个月组未复发率明显高于DAT>12个月组(P＜0.05)，前两组间差异无统计学意义；持续性房颤患者3组间消融术后的累积未复发率差异有统计学意义(P＜0.05)，DAT 0~6个月组明显高于DAT 6~12个月组和DAT>12个月组(P＜0.05)，后两组间差异无统计学意义。 结论 房颤患者尽早接受导管消融有较高的未复发率，阵发性房颤患者在DAT < 12个月内、持续性房颤患者在DAT < 6个月内接受导管消融有助于降低术后复发率。Abstract: Objective To analyze the correlation between the diagnosis-to-ablation time(DAT) and recurrence after atrial fibrillation(AF) ablation retrospectively, and explore the optimal time of DAT. Methods Patients with AF who underwent radiofrequency ablation for the first time at our hospital from January 2017 to January 2022 were selected for regular follow-up at an outpatient or by telephone after discharge. Multifactorial logistic regression was used to analyze factors influencing recurrence after AF ablation. The Kaplan-Meier survival curve was used to analyze the non-recurrence rate in AF patients after ablation. Results A total of 553 patients with AF were enrolled, including 37.1% persistent AF, 44.3% female, a mean age of(62.3±10.21) years, the DAT of 12(3, 48) months. After the mean follow-up time of(26.7±16.36) months, the non-recurrence rate of AF after ablation was 80.3%. Multivariate logistic regression analysis indicated that DAT(OR=1.005, 95%CI: 1.0-1.011, P < 0.05), persistent AF(OR=1.952, 95%CI: 1.160-3.385, P < 0.05) and female(OR=1.698, 95%CI: 1.056-2.731, P < 0.05) was an independent risk factor for recurrence after AF ablation. Kaplan-Meier survival analysis indicated that the non-recurrence rate in the patients with DAT≤12 months was significantly higher than that in the patients with DAT>12 months(84.8% vs. 75.7%, P < 0.05); The non-recurrence rate of persistent AF patients was significantly lower than that of paroxysmal AF patients(76.1% vs. 82.8%, P < 0.05). There was no significant difference between males and females in the non-recurrence rate of AF. Patients were divided into the 0-6 months group, 6-12 months group, and>12 months group according to the DAT interval. There was a significant difference in the cumulative non-recurrence rate after ablation among the three groups in patients with paroxysmal AF, and the non-recurrence rate was significantly higher in the DAT 0-6 months group and DAT 6-12 months groups than that in the DAT>12 months group(P < 0.05), whereas the difference between the former two groups was not statistically significant. In patients with persistent AF, there was a statistically significant difference in the cumulative non-recurrence rate after ablation among the three groups(P < 0.05), and the cumulative non-recurrence rate in the DAT 0-6 months group was significantly higher than that in the DAT 6-12 months group and the DAT>12 months group(P < 0.05), while there was no statistically significant difference between the latter two groups. Conclusion Patients with AF who undergo catheter ablation early have higher non-recurrence rates. Catheter ablation in patients with paroxysmal AF within 12 months of DAT and in patients with persistent AF within 6 months of DAT can help to reduce the recurrence rate.
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Key words:
- atrial fibrillation /
- catheter ablation /
- recurrence /
- diagnosis-to-ablation time
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表 1 患者临床基本资料
Table 1. General clinical data
例(%), X±S, M(P25, P75) 项目 总体(553例) 阵发性房颤组(348例) 持续性房颤(205例) P值 年龄/岁 62.3±10.2 62.1±10.8 62.6±9.2 0.542 女性 245(44.3) 160(46.0) 85(41.5) 0.302 BMI/(kg/m2) 25.1±3.4 24.9±3.3 25.6±3.6 0.022 CHA2DS2VASc评分 2(1，3) 2(1，3) 2(1，3) 0.356 DAT/月 12.0(3.0，48.0) 13.5(4.0，48.8) 12.0(3.0，36.0) 0.122 高血压 330(59.7) 208(59.8) 122(59.5) 0.952 糖尿病 77(13.9) 47(13.5) 30(14.6) 0.711 冠心病 58(10.5) 42(12.1) 16(7.8) 0.114 脑梗死 51(9.2) 37(10.6) 14(6.8) 0.135 心功能不全 89(16.1) 27(7.8) 62(30.2) ＜0.001 LAD/mm 43.7±5.9 41.5±5.0 47.3±5.5 ＜0.001 LVEDd/mm 49.3±4.9 48.8±4.5 50.0±5.5 0.008 LVEF/% 60.8±7.7 62.5±6.3 58.0±9.0 ＜0.001 
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表 2 复发组与未复发组临床基本资料的比较
Table 2. General clinical data in the recurrence group and non-recurrence group
例(%), X±S, M(P25, P75) 项目 未复发组(444例) 复发组(109例) t/z/χ2值 P值 年龄/岁 62.5±10.36 61.5±9.60 0.904 0.366 女性 190(42.8) 55(50.5) 2.084 0.149 持续性房颤 156(35.1) 49(45.0) 3.617 0.057 BMI/(kg/m2) 25.1±3.42 25.1±3.51 0.109 0.913 CHA2DS2VASc评分 2(1，3) 2(1，3) 0.594 0.552 DAT/月 12(3，48) 24(9，48) 2.810 0.005 高血压 260(58.6) 70(64.2) 1.166 0.280 糖尿病 66(14.9) 11(10.1) 1.664 0.197 冠心病 48(10.8) 10(9.2) 0.250 0.617 脑梗死 38(8.6) 13(11.9) 1.186 0.276 心功能不全 74(16.7) 15(13.8) 0.547 0.460 LAD/mm 43.6±5.77 44.0±6.43 0.556 0.579 LVEDd/mm 49.2±4.83 49.5±5.31 0.564 0.573 LVEF/% 60.7±7.53 61.3±8.34 0.744 0.457 PVI 305(68.7) 77(70.6) 0.156 0.693
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表 3 消融术后复发危险因素的多因素logistic回归分析
Table 3. Risk factors for recurrence after ablation analyzed by multivariate logistic regression analysis
项目 OR(95%CI) P值 年龄 0.979(0.955~1.003) 0.080 女性 1.698(1.056~2.731) 0.029 持续性房颤 1.952(1.160~3.285) 0.012 BMI 0.991(0.925~1.061) 0.789 DAT 1.005(1.000~1.011) 0.049 高血压 1.410(0.881~2.258) 0.152 糖尿病 0.587(0.285~1.207) 0.147 冠心病 0.971(0.459~2.052) 0.938 脑梗死 1.750(0.868~3.527) 0.118 心功能不全 0.710(0.337~1.495) 0.367 LAD 0.994(0.949~1.041) 0.792 LVEDd 1.033(0.980~1.088) 0.225 LVEF 1.013(0.976~1.050) 0.501
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