Increased plasma homocysteine predicts arrhythmia recurrence after minimally invasive epicardial ablation for nonvalvular atrial fibrillation
Increased plasma homocysteine predicts arrhythmia recurrence after minimally invasive epicardial ablation for nonvalvular atrial fibrillation
复制标题
DOI：
10.1016/j.jtcvs.2012.07.099
复制
发表时间：
2013-10-01
影响因子：
6
通讯作者：
Speziale, Giuseppe
中科院分区：
文献类型：
--
作者：
Nasso, Giuseppe;Bonifazi, Raffaele;Speziale, Giuseppe
目的：经右胸小切口行微创心外膜消融术是药物难治性非瓣膜性房颤患者的一种新兴选择。为了指导合理治疗算法的开发，需要量化并最终治疗诱发心律失常复发的因素。我们解决了血浆同型半胱氨酸水平和微创ablation.Methods后房颤复发的关联：我们获得了104例患者的外周血样本，在后续的心律失常手术后，同型半胱氨酸浓度表示为微摩尔每升。通过心电图霍尔特监测进行前瞻性随访（平均18.5 +/- 5.8个月）。分层分析（高同型半胱氨酸vs低同型半胱氨酸）基于同型半胱氨酸浓度最后四分位数的截止值（16 μ mol/L）。事件发生时间和诊断性能进行了analysed.Results：率的自由从房颤是89.4%，在随访结束。循环同型半胱氨酸水平升高、持续性房颤类型和左心房内径增大独立预测随访期间房颤复发（校正考克斯回归）。高同型半胱氨酸水平的患者更容易发生房颤复发（分层Kaplan-Meier，P
Objective: Minimally invasive epicardial ablation via right minithoracotomy is an emerging option for patients with drug-refractory nonvalvular atrial fibrillation. To guide the development of rational treatment algorithms, factors predisposing to recurrence of arrhythmia need to be quantified and eventually treated. We addressed the association of the plasma levels of homocysteine and the recurrence of atrial fibrillation after minimally invasive ablation.Methods: We obtained peripheral blood samples from 104 patients at follow-up after arrhythmia surgery; the homocysteine concentration was expressed as micromoles per liter. Prospective follow-up was conducted through electrocardiogram Holter monitoring (average 18.5 +/- 5.8 months). Stratified analysis (high vs low homocysteine) was based on the cutoff value for the last quartile of homocysteine concentration (16 mu mol/L). Time-to-event and diagnostic performance analyses were performed.Results: The rate of freedom from atrial fibrillation was 89.4% at the end of follow-up. Elevated circulating homocysteine level, persistent type of atrial fibrillation, and increased left atrial dimension independently predicted the recurrence of atrial fibrillation during the follow-up (adjusted Cox regression). Patients with a high homocysteine level were more likely to have atrial fibrillation recurrence (stratified Kaplan-Meier, P