阻塞性睡眠呼吸暂停低通气综合征严重程度对射频消融术后心房颤动复发的影响

摘要

Objective:To investigate the effects of severity of obstructive sleep apnea hypopnea syndrome (OSAHS) on the success rate of catheter ablation for atrial fibrillation (AF).Methods:From January 2011 to June 2015,a total of 126 AF patients who underwent catheter ablation guided by 3D mapping system and had been diagnosed as OSAHS by sleep monitoring were enrolled.22 patients were mild OSAHS,47 patients were moderate OSAHS and 57 patients were sever OSAHS,basic data and arrhythmia recurrence rate were compared.Risk factors associated with arrhythmia recurrence were determined by univariate analysis and Logistic regression analysis.Results:After (16.5 ± 14.3) months' follow-up,arrhythmia recurrence of sever OSAHS group was 66.7％,which was obvious higher than that of mild OSAHS group(P =0.014),but had no significant difference compared with noderate OSAHS group.Logistic regression analysis showed AHI (OR =1.04,95％ CI:1.01 ～ 1.08,P =0.016) 、BMI(OR =1.12,95％ CI:1.00 ～ 1.26,P =0.045) 、coronary heart disease (OR =4.38,95 ％ CI:1.09 ～ 17.52,P =0.037) and left ventricularend diastolic diameter (LVEDD)(OR =1.11,95％ CI:1.03 ～ 1.20,P =0.006) were predictors of the recurrence.Fuaher adjusted for left atrial diameter(LAD),only LAD was an independent predictor of the recurrence(OR =1.30,95％ CI:1.16 ～1.46,P ＜ 0.0001).Conclusion:The recurrence of AF after catheter ablation is associated with the severity of OSAHS,AHI,BMI,coronary heart disease,LAD and LVEDD have great impact on the recurrence of AF in patients with OSAHS.%目的:观察不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对心房颤动射频消融效果的影响,并探讨OSAHS患者心房颤动复发的预测因素.方法:回顾性分析自2011年01月至2015年06月,在北京安贞医院行导管消融术并经多导睡眠监测诊断为OSAHS的心房颤动患者126例,根据睡眠呼吸暂停低通气指数(AHI)分为轻度OSAHS组22例,中度OSAHS组47例,重度0SAHS组57例,比较各组患者基础资料及心房颤动复发率,对可能影响OSAHS患者术后心房颤动复发的因素行单因素分析和Logistic回归分析.结果:术后平均随访(16.5±14.3)个月,重度OSAHS患者心房颤动复发率为66.7％,明显高于轻度OSAHS患者复发率36.4％ (P =0.014),但与中度OSAHS患者复发率57.4％差异无统计学意义(P=0.334).经多因素二元Logistic回归分析显示,AHI(OR=1.04,95％ CI:1.01～1.08,P=0.016)、体质量指数(BMI)(OR=1.12,95％ CI:1.00 ～ 1.26,P=0.045)、冠心病病史(OR=4.38,95％ CI:1.09 ～ 17.52,P=0.037)和左心室舒张末径(LVEDD)(OR=1.11,95％ CI:1.03～1.20,P =0.006)是OSAHS患者心房颤动复发的预测因素.进一步校正左心房前后径(LAD),Logistic回归分析发现只有LAD是复发的独立预测因素(OR =1.30,95％ CI:1.16 ～ 1.46,P＜0.0001).结论:OSAHS严重程度与心房颤动射频消融术的复发相关,AHI、BMI、LAD、LVEDD和冠心病病史是影响OSAHS患者心房颤动导管消融复发的重要因素.