| Objective: To investigate the effectiveness of radiofrequency catheter ablation(RFCA) in the treatment of paroxysmal atrial fibrillation(PAF) with tachy-brady syndrom e(TBS), paroxysmal atrial fibrillation(PAF) with sinus node dysfunction(SN D), and analyze the mechanism of PAF with TBS, PAF with SND.Methods: 228 patients of P AF under RFCA from January 2012 to Decem ber 2014 were analyzed, aged 24-75 years old(average 61.1), 139 men, 89 women. All patients were divided into 4 groups on the basis of electrocardiogram(ECG) and 24 hour dynam ic electrocardiogram(Holter): PAF with TBS w ithout SND for group 1(23 cases); P AF with SND without TBS as group 2(13 cases); P AF with TBS with SND as group 3(12 cases); PAF without TBS without SND for groups 4(180 cases). All patients were treated with RFCA and the clin ical data were recorded. Patients were followed up for 12 m onths, and then atrial fibrillation(AF) recurrence rate, implantation of pacem aker(PM) rate were compared. Sinus average heart rate(SMHR), the long RR interval MRRI value and the times of RR interval>2S during 24 hours were com pared on the basis of Holter of preoperative and postoperative 3 months.Results: General clinical data: there were no significant difference in gender, duration, hypertension, diabetes, blood urea(BUN), creatinine(CR), uric acid(UA), total cholesterol(TC), triglyceride(TG), low den sity cholesterol(LDL-C), high d ensity cholesterol(HDL-C), high-sensitivity C-reactive protein(hs-CRP), left atrial diameter(LAD), left v entricular diastolic end diastolic diameter(LVD), left v entricular ejection fraction(LVEF) among four groups. T he mean age of patients in group 2 was larger than patients in group 1. T here was no significant difference in the age of the patients among other groups. RFCA in ablation: 228 patients underwen t circumferential pulmonary vein isolation(CPVI), 50 patients underwent additional ablation: among them, 33 cases underwent isolation of superior ve na cava(SVCI), 14 cases underwent tricuspid isthmus linear ablation, 7 patients underwen t mitral isthmus linear ablation, 6 cases underwent ablation of the top of left atrium, 5 cases of terminal crest ablation, and 1 patient with right atrial ablation, and 1 patient with left atrial ablation, 2 cas es of coronary sinus ablation. Additional ablation of the four groups were com pared: group 1 was 39.1%(9/23), group 2 was 61.5%(8/13), group 3 was 50%(6/12), and group 4 was 15%(27/180). Group 1, group 2, group 3 were significan tly higher than group 4. Group 2 was significantly higher than group 1. Clinical f ollow-up results after RFCA: all patients were followed up for 12 months. The total AF recurrence rate was 27.6%(63/228), 34.8%(8 /23) in group 1, 61.5%(8/13) in group 2, 33.3%(4/12) in gr oup 3, and 23.9%(43/180) in group 4. AF recurrence rate of group 2 was significantly higher than group 1, group 3, and group 4, while there was no significant dif ference among group 1, group 3, an d group 4. The total PM rate was 4.4%(10/228), 8.7%(2/23) in group 1, 46.2%(6/13) in group 2, 16.7%(2/12) in group 3, and 0%(0/180) in group 4. PM rate of group 2 was significantly higher than group 1, group 3, and group 4, while there wa s no significant dif ference among group 1, group 3, and group 4. RFCA preoperative and pos toperative 3 months of Holter results: comparison of SMHR: 78.5bpm and 59.7bpm of group 1; 58.7bpm and 64.2bpm of group 2; 59.3bpm and 57.2bpm of group 3; 64.3bpm and 63.4bpm of group 4. 24 hours RR>2S times between: 4.8 times and 4.8 times of group 1; 13.5 times and 27.5 times of group 2; 35.5 times and 5.7 times of group 3; 0 tim es and 1.6 times of group 4. Com parison of MRRI: 2.8s and 1.8s of group 1; 2.4s and 3.0s of group 2; 3.2s and 2.3s of group 3; 1.5S and 1.6s of group 4. The additional ablation for AF recurrence after operation: AF recurrence rate was 22%(11 cases) in patien ts underwent CPVI com bined with additional ablation, and 29.2%(52/178) in patients underwent simple CPVI. In group 1, AF recurrence rate was 22.2%(2/9) in patients underwent CPVI combined with additional ablation, and 42.9%(6/14) in patients underwent sim ple CPVI. In group 2, AF recurrence rate was 50%(4/8) in patients underwent CPVI combined with additional ablation, and 80%(4/5) in patients underwent simple CPVI. In group 3, AF recurrence rate was 33.3%(2/6) in patients underwent CPVI combined with additional ablation, and 33.3%(2/6) in patients underwent simple CPVI. And in gr oup 4, AF recurrence rate was 11.1%(3/27) in patients underwent CPVI combined with additional ablation, and 26.1%(40/153) in patients underwent simple CPVI. Analysis of predictive factors of AF recurrence and PM im plantation and postoperative: through COX regression anal ysis found that: P AF patients with SND without TBS after the risk of AF r ecurrence was higher(RR=3.671 95%, CI 1.651-8.160, P=0.001), while the duration of atrial fibrillation and left atrial diameter were independent risk factors of AF recurren ce too. PAF patients with SND without TBS after implantation of PM significantly increased risk(RR=36.158 95%, CI 6.453-202.595, P=0.000), while MRRI0 is the independent risk factors for PM implantation too.Conclusion: There was no significant dif ference of AF r ecurrence rate and PM implantation rate among group 1, group 3, and group 4. The patients of group 1 and group 3 often need CPVI combined with additiona l ablation to reduce the incidence of AF recurrence. Therefore, RFCA could be chosen as the preferred treatment for the patients in group 1 and 3. Otherwise, AF recurrence rate and PM implantation rate of group 2 was significantly higher than that of group 4. The patients of group 2 also need CPVI combined with additional ablation to reduce AF recurre nce rate, but AF recurre nce rate was still significantly higher than group 1, 3 and 4. Therefore, it is better to select PM implantation combined with anti-arrhythmic drug for the patients in group 2. |
PDF Full Text Request