糖尿病房颤导管消融进展

    Research progress of diabetes mellitus with atrial fibrillation

    • 摘要: 糖尿病是临床上常见的代谢性疾病,房颤是最常见的心律失常之一,两者常合并存在。流行病学研究发现,糖尿病和房颤间存在着相关性,糖尿病人群中房颤的发生率较非糖尿病人群高。基础研究关注了糖尿病易诱发房颤的病理生理学机制,但目前仍尚不完全明确,现在大多数人认为其与心房结构重构、电重构和自主神经重构有关。相比于传统的抗心律失常药物,导管消融在治疗房颤中具有显著优势,体现在术后较药物治疗更低的复发率和良好的预后方面。房颤患者选择导管消融治疗,无论是否患有糖尿病,冷冻消融策略似乎比射频消融效果更佳,当患者合并糖尿病时,术后复发风险增高,尤其是在糖尿病病程较长和血糖控制较差的情况下。近些年的临床研究中,降糖药物、血糖控制、消融术式等是影响糖尿病合并房颤患者术后复发的危险因素,而糖尿病与房颤的复发关系,目前尚缺乏大规模的多中心随机对照研究予以证实。

       

      Abstract: Diabetes is a common metabolic disease in clinical practice, atrial fibrillation is one of the most common arrhythmias and the two are often combined. Epidemiological studies have found that there is a correlation between diabetes and atrial fibrillation and the incidence of atrial fibrillation in diabetic people is higher than that in non-diabetic people. Some basic studies have paid attention to the pathophysiological mechanism of diabetes prone to atrial fibrillation, but it is still not completely clear and most researchers believe it is related to atrial structural remodeling, electrical remodeling and autonomic nerve remodeling. Compared with traditional antiarrhythmic drugs, catheter ablation has significant advantages in the treatment of atrial fibrillation, which is reflected in its lower postoperative recurrence rate and better prognosis than drug therapy. For patients with atrial fibrillation who choose catheter ablation, regardless of whether they have diabetes, cryoablation appears to be a better ablation strategy than radiofrequency ablation. The risk of postoperative recurrence is increased in patients with diabetes. In recent clinical studies, hypoglycemic drugs, blood glucose control and ablation methods are risk factors for postoperative recurrence in patients with diabetes complicated with atrial fibrillation. However, the relationship between diabetes and recurrence of atrial fibrillation has not been confirmed by large-scale multi-center randomized controlled studies.

       

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