摘要
目的观察尼非卡兰在长程持续性心房颤动(房颤)导管消融术中转复窦性心律(转律)的成功率及影响因素。方法回顾性分析辽宁省人民医院心血管病治疗中心2023年3月至2024年3月在非瓣膜性长程持续性房颤(持续时间≥1年)导管消融术中应用尼非卡兰的患者73例。搜集患者的年龄、性别、房颤持续时间、左心房内径等临床数据,记录术中对左心房进行三维标测后得出的左心房容积,记录房颤转律的情况。根据是否静脉应用尼非卡兰后转律成功分为药物转律组和非药物转律组,比较两组临床基本资料。结果本研究回顾性观察73例入组患者,平均年龄(60.3±9.2)岁,男51例(69.9%),房颤持续时间(18.3±22.9)个月。术中应用尼非卡兰成功转律者(药物转律组)45例(61.6%);非药物转律组共28例(38.4%),其中转为心房扑动者为6例(8.2%),仍为房颤者22例(30.1%)。对药物转律组和非药物转律组(包括用药后仍为心房扑动以及房颤者)的患者进行临床数据比较,两组在房颤持续时间[(20.7±16.3)个月比(32.6±17.6)个月,P=0.014]、左心房内径[(44.1±3.1)mm比(44.8±5.2)mm,P=0.039]、左心房容积[(111.9±21.8)ml比(134.9±35.1)ml,P=0.032]比较,差异均有统计学意义。二元Logistic回归分析后可见房颤持续时间(OR 0.443,95%CI 1.005~2.139,P=0.029)、左心房内径(OR 0.339,95%CI 1.357~2.462,P=0.041)、左心房容积(OR 0.454,95%CI 1.036~1.985,P=0.040)是影响房颤消融结束后即刻应用尼非卡兰是否可转律的主要因素。结论尼非卡兰在长程持续性房颤导管消融术中转律的成功率较高,在房颤发作早期、左心房内径及左心房容积接近正常的患者中转律成功率更为显著。
Objective To observe the success rate of cardioversion by applying Nifekalant after catheter ablation of long-term persistent atrial fi brillation and analysis the potential infl uencing factors.Methods A retrospective analysis was conducted on 73 patients who underwent catheter ablation for non-valvular long-term persistent atrial fibrillation(duration>1 year)at the Cardiac Center of Liaoning Provincial People’s Hospital from March 2023 to March 2024,with the application of Nifekalant after ablation aim to convert to sinus rhythm.Clinical data such as patient age,gender,duration of atrial fibrillation,and left atrial diameter were collected.We also record the left atrial volume which is derived from three-dimensional mapping during the procedure,as well as the cardioversion status of applying Nifekalant after ablation.Patients were divided into 2 groups(successful conversion group and non-conversion group)based on whether they converted to sinus rhythm after intravenous application of Nifekalant,and the aforementioned data of the two groups were compared.Results This study retrospectively observed 73 enrolled patients,with 51 males and 22 females;the average age was(60.3±9.2)years;the duration of atrial fi brillation was(18.3±22.9)months;45 cases(61.6%)successfully converted to sinus rhythm with the application of Nifekalant,6 cases(8.2%)converted to atrial flutter,and 22 cases(30.1%)remained in atrial fi brillation.A comparison of clinical data between the successful conversion group and the non-conversion group(including those who remained in atrial flutter and atrial fibrillation after medication)revealed significant statistical differences in the duration of atrial fibrillation[(20.7±16.3)months vs.(32.6±17.6)months,P=0.014]and left atrial diameter between the two groups[(44.1±3.1)mm vs.(44.8±5.2)mm,P=0.039],and a statistical difference in left atrial volume[(111.9±21.8)ml vs.(134.9±35.1)ml,P=0.032].Bivariate Logistic regression analysis revealed that the duration of atrial fibrillation(OR 0.443,95%CI 1.005-2.139,P=0.029).the left anterior descending artery(OR 0.339,95%CI 1.357-2.462,P=0.041)and the left atrial volume(OR 0.454,95%CI 1.036-1.985,P=0.040)were the primary factors influencing whether immediate administration of Nifekalant after atrial fibrillation ablation could achieve cardioversion.Conclusions Nifekalant has an acceptable success rate in converting long-standing persistent atrial fibrillation during procedure after catheter ablation.The success rate of cardioversion is negatively correlated with the duration of atrial fi brillation,left atrial diameter,and left atrial volume,with the fi rst two factors being particularly signifi cant.
作者
孙胜楠
王昊
刘海涛
玄研华
朱宇
杨桂棠
SUN Sheng-nan;WANG Hao;LIU Hai-tao;XUAN Yan-hua;ZHU Yu;YANG Gui-tang(Department of Cardiology,People's Hospital of Liaoning Province,Shenyang 110016,China)
出处
《中国介入心脏病学杂志》
2025年第12期709-714,共6页
Chinese Journal of Interventional Cardiology
基金
辽宁省科学技术计划项目(2023-MSLH-139)。
