关键词: 心房颤动, 每搏输出量, 肺静脉, 导管消融, 预后, 影响因素分析

Abstract: Background　Non-pulmonary vein triggers ablation combined with pulmonary vein isolation can effectively reduce postoperative complications，but its efficacy and long-term outcome on atrial fibrillation in patients with low left ventricular ejection fraction（LVEF） were still unclear.Objective　To investigate the effects of non-pulmonary vein triggers ablation on prognosis in patients with atrial fibrillation and low LVEF and its influencing factors.Methods　A total of 307 patients with paroxysmal atrial fibrillation who underwent primary catheter ablation admitted to Tianjin Fifth Central Hospital from December 2015 to January 2016 were enrolled and divided according to their LVEF：LVEF≤40 % were in groupⅠ（83 cases），LVEF >40.00% in groupⅡ（224 cases）；the patients in groupⅠwere further divided intoⅠA subgroup（41 cases，non-pulmonary vein triggers ablation combined with pulmonary vein isolation） andⅠB subgroup（42 cases，pulmonary vein isolation）．Pulmonary vein isolation was applied in groupⅡ.The patient's clinical data〔age，gender，duration of disease and treatment history，underlying disease，left atrial diameter（LAD），LVEF，medication history，New York Heart Association （NYHA） cardiac function classification〕were recorded at admission.Surgical parameters（total operating time，fluoroscopy time，ablation time，and proportion of non-pulmonary vein triggers） in each group were recorded during operation.During the follow-up period，the success rate，complications，recurrence of atrial fibrillation after operation of each group were recorded.At the end of follow-up，the LVEF of two subgroups were analyzed and compared with preoperative data.The Kaplan-Meier method was used to draw survival curves of postoperative recurrence of atrial fibrillation and then was compared by Log-rank test.Factors influencing postoperative recurrence of atrial fibrillation in patients with low LVEF were analyzed by multivariate Cox regression analysis.Results　The utilization rate of pacemaker/implantable cardioverter defibrill（ICD），left atrial diameter（LAD），angiotensin converting enzyme（ACE） inhibitor/angiotensin receptor blockers（ARBs），and roportion of patients with non-pulmonary vein triggers in groupⅠwas higher than those in groupⅡ（P<0.05）．The total operation time，fluoroscopy time and ablation time of patients in subgroupⅠA were significantly longer than those in subgroupⅠB（P<0.05）．The success rate of operation in groupⅡwas higher than that in groupⅠ，and success rate of subgroupⅠA was higher than that of subgroupⅠB（P<0.05）．There were significant difference in survival curves of recurrence of atrial fibrillation between groupⅠand groupⅡ（P<0.001）；there were significant difference in survival curves of recurrence of atrial fibrillation between subgroup ⅠA and Ⅱ subgroup（P=0.029）；and there was no significant difference in the incidence of complications between groupⅠand groupⅡ（P=0.875）．The LVEF〔（36.54±4.17）%〕at the end of follow-up in subgroupⅠA was higher than that before operation〔（32.17±2.48）%〕（P<0.001）;There was no significant difference in LVEF in subgroupⅠB before〔（31.94±3.15）%〕and after operation〔（31.86±2.21）%〕（P>0.05）．The results of multivariate Cox regression analysis showed that coronary artery disease，LVEF≤40.00%  and non-pulmonary vein triggers were influencing factors of recurrence of atrial fibrillation（P<0.05）．Conclusion　There are more non-pulmonary vein triggers in patients with atrial fibrillation and low LVEF and pulmonary vein isolation combined with non-pulmonary vein triggers ablation can improve the success rate of patients with low-paroxysmal atrial fibrillation.The coronary artery disease，LVEF≤40.00%  and non-pulmonary vein triggers were the influencing factors of recurrence of atrial fibrillation.

Key words: Atrial fibrillation, Stroke volume, Pulmonary veins, Catheter ablation, Prognosis, Root cause analysis