目的:先前的研究已经证明了eNOS多态性与心房颤动(AF)之间的关联。我们试图确定eNOS多态性是否与射频导管消融(RFCA)后的房颤复发有关。
方法:共500名连续患者(56±11年,77%男性)阵发性(68%)或持续性(32%)房颤,接受RFCA和500岁,对性别匹配的对照进行eNOS3单核苷酸多态性基因分型(rs1799983).根据2012年ACC/AHA/ESC指南监测房颤复发。
结果:病例组和对照组rs1799983变异等位基因(T)的频率没有显着差异(OR1.05,95%CI0.75-1.46,p=0.798)。具有rs1799983变异的AF患者比没有该基因遗传变异的患者更有可能患有冠状动脉疾病或中风(31.0%vs.17.3%,p=0.004)。在平均17个月的随访期间,房颤早期复发(ERAF;3个月内)和临床复发(CR)分别为31.8%和24.8%,分别。rs1799983变异与较高的ERAF风险相关(OR1.71,95%CI1.06-2.79,p=0.028),但不是CR。变异组ERAF发生时间(11±16天)高于无变异等位基因组(20±25天,p=0.016)。多因素logistic回归分析显示rs1799983变异体(OR1.75,95%CI1.07-2.86,p=0.026)和持续性房颤是房颤消融术后ERAF的独立预测因子。
结论:eNOS3基因的rs1799983变体与ERAF相关,但不是CR,在RFCA之后。eNOS3基因变异可能对消融后管理的分层具有潜在作用。
OBJECTIVE: Previous studies have demonstrated an association between eNOS polymorphisms and atrial fibrillation (AF). We sought to determine whether eNOS polymorphisms are associated with AF recurrence after a radiofrequency catheter ablation (RFCA).
METHODS: A total of 500 consecutive patients (56±11 years, 77% male) with paroxysmal (68%) or persistent (32%) AF who underwent RFCA and 500 age, gender-matched controls were genotyped for the eNOS3 single nucleotide polymorphism (rs1799983). AF recurrence was monitored according to 2012 ACC/AHA/ESC guidelines.
RESULTS: The frequencies of the rs1799983 variant alleles (T) in the case and control group were not significantly different (OR 1.05, 95% CI 0.75-1.46, p=0.798). AF patients with rs1799983 variants were more likely to have coronary artery disease or stroke than those without genetic variant at this gene (31.0% vs. 17.3%, p=0.004). During mean 17 months follow-up, early recurrence of AF (ERAF; within 3 months) and clinical recurrence (CR) of AF were 31.8% and 24.8%, respectively. The rs1799983 variant was associated with higher risk of ERAF (OR 1.71, 95% CI 1.06-2.79, p=0.028), but not with CR. ERAF occurred earlier (11±16 days) in variant group than those without variant allele (20±25 days, p=0.016). A multiple logistic regression analysis showed that presence of the rs1799983 variant (OR 1.75, 95% CI 1.07-2.86, p=0.026) and persistent AF were independent predictors for ERAF after AF ablation.
CONCLUSIONS: The rs1799983 variant of the eNOS3 gene was associated with ERAF, but not with CR, after RFCA. eNOS3 gene variants may have a potential role for stratification of post-ablation management.