Impact of Metabolic Syndrome on Procedural Outcomes in Patients With Atrial Fibrillation Undergoing Catheter Ablation
Impact of Metabolic Syndrome on Procedural Outcomes in Patients With Atrial Fibrillation Undergoing Catheter Ablation
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DOI：
10.1016/j.jacc.2011.11.051
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发表时间：
2012-04-03
影响因子：
24
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
--
作者：
Mohanty, Sanghamitra;Mohanty, Prasant;Natale, Andrea
目的探讨代谢综合征（MS）对心房颤动（AF）患者导管消融术后复发和生活质量的影响。背景MS是一种促炎症状态，与高血压、糖尿病、血脂异常和肥胖密切相关。将496例连续房颤患者（29%为阵发性房颤，26%为持续性房颤，45%为长期持续性房颤）进行首次消融，分为MS患者（第1组; n = 485）和无MS患者（第2组; n = 1，011）。随访患者的复发和生活质量。结果随访21 +/- 7个月后，第1组189例（39%）和第2组319例（32%）心律失常复发（p = 0.005）。按房颤类型分层时，第1组非阵发性房颤患者的失败率高于第2组（150例[46%] vs. 257例[35%]，p = 0.002）;阵发性房颤亚组无差异（39例[25%] vs. 62例[22%]，p = 0.295）。第1组患者在所有SF-36健康调查子量表上的基线评分均显著较低。随访时，第1组的心理健康总评（Delta 5.7 +/- 2.5，p < 0.001）和身体健康总评（Delta 9.1 +/- 3.7，p < 0.001）评分均有所改善，而第2组仅心理健康总评（Delta 4.6 +/- 2.8，p = 0.036）评分有所改善。在非阵发性房颤亚组中，MS、性别、C反应蛋白>= 0.9 mg/dl和白色血细胞计数是复发的独立预测因子。结论基线炎症标志物和MS的存在仅在非阵发性房颤患者中预测单导管消融后复发率较高。此外，消融后MS人群生活质量显著改善。（J Am科尔心脏病学杂志2012;59：1295-301）（C）美国心脏病学会基金会2012年
Objectives The aim of this study was to investigate impact of metabolic syndrome (MS) on outcomes of catheter ablation in patients with atrial fibrillation (AF) in terms of recurrence and quality of life (QoL).Background MS, a proinflammatory state with hypertension, diabetes, dyslipidemia, and obesity, is presumed to be a close associate of AF.Methods In this prospective study, 1,496 consecutive patients with AF undergoing first ablation (29% with paroxysmal AF, 26% with persistent AF, and 45% with long-standing persistent AF) were classified into those with MS (group 1; n = 485) and those without MS (group 2; n = 1,011). Patients were followed for recurrence and QoL. The Medical Outcomes Study SF-36 Health Survey was used to assess QoL at baseline and 12 month after ablation.Results After 21 +/- 7 months of follow-up, 189 patients in group 1 (39%) and 319 in group 2 (32%) had arrhythmia recurrence (p = 0.005). When stratified by AF type, patients with nonparoxysmal AF in group 1 failed more frequently compared with those in group 2 (150 [46%] vs. 257 [35%], p = 0.002); no difference existed in the subgroup with paroxysmal AF (39 [25%] vs. 62 [22%], p = 0.295). Group 1 patients had significantly lower baseline scores on all SF-36 Health Survey subscales. At follow-up, both mental component summary (Delta 5.7 +/- 2.5, p < 0.001) and physical component summary (Delta 9.1 +/- 3.7, p < 0.001) scores improved in group 1, whereas only mental component summary scores (Delta 4.6 +/- 2.8, p = 0.036) were improved in group 2. In the subgroup with nonparoxysmal AF, MS, sex, C-reactive protein >= 0.9 mg/dl, and white blood cell count were independent predictors of recurrence.Conclusions Baseline inflammatory markers and the presence of MS predicted higher recurrence after single-catheter ablation only in patients with nonparoxysmal AF. Additionally, significant improvements in QoL were observed in the post-ablation MS population. (J Am Coll Cardiol 2012;59:1295-301) (C) 2012 by the American College of Cardiology Foundation