年龄对阵发性心房颤动终止后长间歇患者窦房结功能的影响

Impact of age on sinus node function in patients with prolonged sinus pauses after termination of paroxysmal atrial fibrillation

摘要:

目的 探讨年龄对阵发性心房颤动（房颤）终止后出现长间歇的患者窦房结功能的影响。方法 连续入选2011年5月至2013年5月于我院就诊的358例接受射频消融术的阵发性房颤患者，年龄（63±11）岁，男220例，女138例。根据年龄将其分为两组：即非老年组（年龄＜65岁，n＝177）及老年组（年龄≥65岁，n＝181）。比较两组患者术前长间歇的检出率及术后窦房结功能的恢复率。结果 老年阵发性房颤患者术前更易出现提示窦房结功能障碍的房颤终止后长间歇，其检出率显著高于非老年组（14.4% vs 5.6%，P＜0.01）。术后随访（15.0±8.7）个月，非老年组的窦房结功能障碍检出率显著低于术前（1.1% vs 5.6%，P＜0.05），而老年组仅有降低趋势（9.4% vs 14.4%，P＞0.05）。老年患者术后窦房结功能的好转率显著低于非老年患者（34.6% vs 80.0%，P＜0.05）。结论 年龄对阵发性房颤终止后出现长间歇患者的窦房结功能评价具有重要价值。老年房颤患者经射频消融术治疗后，多数窦房结功能无明显改善，常须植入永久起搏器治疗。

Abstract:

Objective To determine the impact of age on the sinus node function in the patients with prolonged sinus pauses after termination of paroxysmal atrial fibrillation (PAF). Methods A total of 358 consecutive PAF patients with age of (63±11) years (220 males and 138 females) who received radiofrequeney ablation in our department from May 2011 to May 2013 were enrolled in this study. They were divided into 2 groups: older group (n＝181, ≥65 years old) and non-older group (n＝177, ＜65 years old). The prevalence of prolonged sinus pauses before the ablation and the rate of sinus node functional restoration after procedure were compared between the 2 groups. Results The older patients tended to have higher prevalence of prolonged sinus pauses after termination of PAF (indicating sinus node dysfunction) than non-older patients (14.4% vs 5.6%, P＜0.01). After the follow-up of (15.0±8.7) months, the prevalence of sinus node dysfunction was significantly lower than before catheter ablation in non-older group (1.1% vs 5.6%, P＜0.05). But there was only a decreasing trend in older patients (9.4% vs 14.4%, P＞0.05). The rate of sinus node functional restoration was significantly lower in older patients than in non-older ones, (34.6% vs 80.0%, P＜0.05). Conclusion Age plays an important role in the evaluation of sinus node function in patients with prolonged sinus pauses after termination of PAF. For the elderly patients with PAF, radiofrequency ablation exerts no obvious effect on sinus node function, and permanent pacemaker implantation is recommended in this situation.