单次冷冻球囊消融治疗心房颤动长期随访效果  

Long-term follow-up outcome of single cryoballoon ablation for atrial fi brillation

作　　者：刘俊[1] 唐闽[1] Jan Kaufmann Charalampos Kriatselis Eckart Fleck 李劲宏 方丕华[1] 张澍[1] 

机构地区：[1]中国医学科学院心血管病研究所 北京协和医学院阜外心血管病医院心律失常诊治中心,100037 [2]德国心脏病中心(柏林)心内科

出　　处：《中国介入心脏病学杂志》2014年第5期278-282,共5页Chinese Journal of Interventional Cardiology

基　　金：北京市科技计划项目(2012BKJ09)

摘　　要：目的分析冷冻球囊消融(CBA)治疗心房颤动(房颤)患者的单中心长期随访效果,探讨影响其疗效的相关临床因素。方法回顾性分析2009年1月至2013年4月接受CBA治疗的房颤患者的住院病历资料、手术记录和门诊随访资料。术前经胸超声测量左心房内径(LAD)。术后3个月后出现的房颤、心房扑动(房扑)、房性心动过速(房速)发作判定为CBA治疗失败。结果 199例房颤接受CBA治疗,术中并发膈神经麻痹3例(1.5%),术后发生心包积液1例(0.5%)、短暂性脑缺血发作1例(0.5%),均自行缓解。在平均(23±14)个月随访中152例患者完成随访,其中65例(42.8%)治疗成功,失败患者中75例(86.2%)为术后12个月内复发。失败患者年龄较大[(62±7)比(52±10),P=0.0379]、LAD较大[(47±7)mm比(43±6)mm,P<0.0001],持续性房颤患者治疗成功率(29.5%)明显低于阵发性房颤患者(48.1%)。Logistic回归分析显示年龄[OR=1.037(1.000,1.076),P=0.0488]和LAD[OR=0.896(0.842,0.953),P=0.005]能独立预测初次CBA治疗效果。结论 CBA治疗房颤安全有效,长期随访效果较好。房性心律失常复发主要发生在术后12个月内。年龄和LAD是预测术后复发的独立危险因素。Objective To analyse long-term follow-up outcome of cryoballoon ablation （CBA） for atrial ifbrillation （AF） in a single center and to investigate the clinical relative factors which affecting the effect. Methods The inpatient, operating and outpatient data of patients, who were treated by CBA for AF in our center from January 2009 to April 2013, were retrospectively analyzed. Left atrium diameter （LAD） was measured by transthoracic echocardiography. Failure-treatment of CBA was defined by episode of AF, atrial lfutter, atrial tachycardia lasted for 30 seconds after 3 months. Results A total of 199 patients were enrolled. The rates of phrenic nerve paralysis, pericardial effusion, transient ischemic attack were 1.5%（n=3）, 0.5%（n=1）, 0.5%（n=1）,respectively. All complications were resolved spontaneously.152 patients had completed follow-up data after ifrst-time CBA during a long-term follow-up of mean 23±14 months, 65 patients （42.8%） treated success. 75 patients with failure-treated were （86.2%） experienced the atrial＆amp;nbsp;arrhythmia recurrence in ifrst 12 month. The characteristics of failure-treated patients included with older age[（62±7） years vs. （52±10） years, P=0.0379]and larger LAD[（48±6）mm vs. （43±6） mm, P〈0.0001]. The Logistic analysis showed that LAD[OR=0.896（0.842,0.953）, P=0.005]and age[OR=1.037 （1.000,1.076）, P=0.0488]could individually predict the treat-failure after ifrst CBA, and only LAD[OR=0.876 （0.822,0.935）, P 〈 0.0001]could individually predict the total CBA. Conclusions CBA procedure for AF is safe and effective, and the result of long-term follow-up is preferable. Most atrial arrhythmia are recurred during ifrst 12 month after CBA. LAD can individually predict the failure in treatment of CBA.

关 键 词：冷冻球囊 冷冻消融 心房颤动 长期随访 

分 类 号：R541.7[医药卫生—心血管疾病]