中文摘要：

目的研究不同类型的年轻心房颤动（房颤）患者（阵发性房颤、持续性房颤和持久的持续性房颤）导管消融治疗成功率和安全性。方法收集广东省心血管病研究所年龄〈45岁,诊断为房颤并接受导管消融治疗的132例患者的临床、电生理及随访资料,应用COX比例风险模型分析初次消融和重复消融后复发的预测因子。结果患者年龄（38.0±5.6）岁,男101例,女31例,既往房颤病程2.05年;阵发性房颤91例,非阵发性房颤包括持续性房颤15例和持久的持续性房颤26例。初次消融后随访24.2个月,阵发性、持续性、持久的持续性房颤成功率分别为86.8%（79例）、66.7%（10例）、57.7%（15例）,总体成功率78.8%。复发的患者有20例（71.4%）再次消融,随访14.3月,12例（75%）维持窦性心律。阵发性、持续性、持久的持续性房颤经过重复消融后窦性心律维持率分别为93.4%（85例）、86.7%（13例）、73.1%（19例）,总体成功率88.6%。COX回归分析提示,初次消融后复发的预测因子分别是非阵发性房颤（HR=3.393,P=0.004）、左心房扩大（HR=1.066,P=0.004）、高血压病史（HR=4.203,P=0.006）和甲状腺疾病史（HR=5.280,P=0.001）;重复消融后复发的预测因子则为右心房扩大（HR=1.133,P〈0.001）和甲状腺疾病（HR=6.942,P=0.003）。无影响预后的严重并发症。结论年轻的房颤患者导管消融安全性好,成功率高。早期对年轻房颤患者进行消融治疗是合理的,但应注意心房扩大及甲状腺疾病对成功率的影响。

英文摘要：

Objectives To evaluate the feasibility and safety of catheter ablation in patients younger than 45 years old with paroxysmal atrial fibrillation （AF）,persistent AF and long-standing persistent AF.Methods We analyzed the clinical,electrophysiological data of 132 patients younger than 45 years old who underwent catheter ablation for AF.COX proportional hazard multivariate regression analysis was performed to identify the predictors for recurrent atrial arrhythmias after ablation.Results The mean age of the patients was（38.0±5.6）years old （101 mals,31 femals）.Of these patients,91 had paroxysmal AF and 41 had none paroxysmal AF （15 had persistent AF and 26 had long-standing persistent AF）.After mean follow-up of 24.2 months,79 patients（86.8%） with paroxysmal AF,10 patients （66.7%） with persistent AF and 15 patients （57.7%） with long-standing persistent AF had free from AF after a single ablation procedure.For arrhythmia recurrences,20（71.4%） patients underwent repeat procedures and 12 patients were free from AF.After repeat procedure,93.4% （85/91） patients with paroxysmal AF,86.7%（13/15） patients with persistent AF and 73.1% （19/26） patients with long-standing persistent AF remained free from AF.The total success rate was 88.6%.COX regression analysis indicated that the predictors for recurrence after initial procedure were non paroxysmal AF （HR=3.393,P=0.004）,larger left atrial size （HR=1.066,P=0.004）,hypertension （HR=4.203,P=0.006） and history of thyroid disorder （HR=5.280,P=0.001）.The predictors for repeat procedurewere were larger right atrial size （HR=1.133,P0.001） and history of thyroid disorder（HR=6.942,P=0.003）.Conclusions Catheter ablation is an effective and safe for treating patients with AF younger than 45 years old.It should be reasonable to consider ablation as a first line therapy in young AF patients,but larger atrial size and history of thyroid disorder may affect the sinus rate after ablation.