2020 年第 11 期 第 15 卷

吸烟状态与阵发性心房颤动患者导管消融术后复发的关系

Association between smoking status and recurrence after catheter ablation in patients with paroxysmal atrial fibrillation

作者：蒋超1 蓝迪慧2 何柳1 赖一炜1 孔祥怡1 夏时俊1郭雪原1 王伟1 李松南1 蒋晨曦1 刘念1 汤日波1 桑才华1 白融1 龙德勇1 杜昕1 董建增1 马长生1

英文作者：Jiang Chao1 Lan Dihui2 He Liu1 Lai Yiwei1 Kong Xiangyi1 Xia Shijun1 Guo Xueyuan1 Wang Wei1 Li Songnan1 Jiang Chenxi1 Liu Nian1 Tang Ribo1 Sang Caihua1 Bai Rong1 Long Deyong1 Du Xin1 Dong Jianzeng1 Ma Changsheng1

单位：1首都医科大学附属北京安贞医院心内科国家心血管疾病临床医学研究中心100029;2首都医科大学附属北京友谊医院心内科100050

英文单位：1Department of Cardiology Beijing Anzhen Hospital Capital Medical University National Clinical Research Center for Cardiovascular Diseases Beijing 100029 China; 2Department of Cardiology Beijing Friendship Hospital Capical Medical University Beijing 100050 China 

关键词：阵发性心房颤动；导管消融；吸烟状态；复发

英文关键词：Paroxysmalatrialfibrillation;Catheterablation;Smokingstatus;Recurrence 

• 摘要：

• 目的 探讨吸烟状态与阵发性心房颤动患者导管消融术后复发的关系。方法 收集2011年8月至2018年12月中国心房颤动注册研究中行导管消融术的4 995例阵发性心房颤动患者的临床资料。根据患者的吸烟状态分为从不吸烟组（3 370例）、戒烟>1年组（827例）、戒烟≤1年组（261例）和目前吸烟组（近1个月内吸烟，每天>1支，537例）。比较4组患者的基线资料和术后心房颤动复发率，采用Cox多因素回归分析吸烟状态与阵发性心房颤动患者导管消融术后复发的关系。结果 4组患者导管消融术后平均随访(27±20)个月，共有2 181例（43.7%）患者心房颤动复发，其中目前吸烟组患者复发率最高，为48.0%（258/537）。多因素Cox回归分析结果显示，在校正基线年龄、性别、体重指数、目前饮酒情况、左心房前后径、教育程度、医疗保险类型和临床疾病史后，目前吸烟组阵发性心房颤动患者导管消融术后复发率较从不吸烟组显著升高（风险比=1.362，95%置信区间：1.159~1.601，P<0.001），戒烟>1年组和戒烟≤1年组复发率较从不吸烟组有升高趋势，但差异无统计学意义（风险比=1.149、1.085，95%置信区间：0.924~1.428、0.948~1.243，P=0.211、0.238）。结论 在阵发性心房颤动患者中，目前吸烟状态与导管消融术后复发率高显著相关。

• Objective To investigate the association between smoking status and recurrence after catheter ablation in patients with paroxysmal atrial fibrillation (AF). Methods From August 2011 to December 2018, the clinical data of 4 995 paroxysmal AF patients who received catheter ablation at enrollment in the China Atrial Fibrillation Registry Study were collected. According to the baseline smoking status, patients were divided into never smoking group(3 370 cases), quit smoking>1 year group(827 cases), quit smoking≤1 year group(261 cases) and current smoking group(>1 cigarette per day in the past month, 537 cases). Baseline characteristics and AF recurrence rate after catheter ablation were compared among 4 groups. Multivariate Cox regression was performed to analyze the association between smoking status and recurrence of paroxysmal AF after catheter ablation. Results After a mean follow-up of (27±20)months, 2 181(43.7%)patients suffered AF recurrence. Patients in the current smoking group had the highest (48.0%, 258/537) recurrence rate. After adjustment for baseline age, gender, body mass index, current alcohol consumption, left atrial anteroposterior diameter, education level, medical insurance and medical history, AF recurrence in current smoking group was significantly higher than that in never smoking group (hazard ratio=1.362, 95% confidence interval: 1.159-1.601， P<0.001). Patients in the quit smoking >1 year or ≤1 year groups held a trend towards higher recurrence than that in never smoking group, but the difference was not significant (hazard ratio=1.149, 1.085, 95% confidence interval： 0.924-1.428, 0.948-1.243, P=0.211, 0.238, respectively). Conclusion Current smoking status was independently associated with a higher AF recurrence rate after catheter ablation in patients with paroxysmal AF.