阵发性心房颤动合并长R-R间期导管消融和起搏治疗的对比  

The comparison of catheter ablation and permanent pacing on patients with paroxysmal atrial fibrillation related tachycardia-bradycardia syndrome

作　　者：陈英伟[1] 董建增[2] 马长生[2] 

机构地区：[1]郑州大学第一附属医院心内科,河南郑州450052 [2]首都医科大学附属北京安贞医院心内科

出　　处：《中国介入心脏病学杂志》2014年第8期477-482,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的评估导管消融对阵发性心房颤动(房颤)相关快-慢综合征的疗效。方法连续入选2010年1月至2012年9月在北京安贞医院房颤中心接受导管消融的50例阵发性房颤合并房颤终止后症状性长间歇的患者作为导管消融组,随访观察导管消融的效果。将同期在北京安贞医院因阵发性房颤相关症状性长间歇植入起搏器的61例患者作为起搏器组。比较随访结束时两组患者的窦性心律维持率、心血管原因再住院率等指标。结果导管消融组50例患者术前均具备起搏器植入的适应证,随访(22.3±10.5)个月后发现其中47例(94.0%)患者不再具备起搏器植入的适应证。随访结束时,起搏器组服用抗心律失常药物的比例多于导管消融组(P<0.001),而窦性心律维持率低于导管消融组(起搏器组为21.3%,导管消融组为82.0%,P<0.001);两组心血管原因再住院率比较,差异无统计学意义(导管消融组22.0%,起搏器组24.6%,P=0.954),而起搏器组因快速心律失常发作再住院率高于导管消融组(起搏器组为14.8%,导管消融组为2.0%,P=0.02);两组血栓事件发生率、心力衰竭发生率、死亡率等终点比较,差异均无统计学意义(均为P>0.05)。结论对于阵发性房颤相关快-慢综合征的患者,导管消融的总体效果可能优于起搏器植入,这类患者大多数经导管消融手术成功根治房颤后,可以不用再植入起搏器。Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation （AF） related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated （ABL group）. In another 61 patients, paroxysmal AF was treated with antiarrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control （PM group）. Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation at the end of follow-up showed that 47 （94%） patients no longer needed a pacemaker （Class Ⅲindication） because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs （PM 42.6%, ABL nbsp;6.0%, P 〈 0.001） while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group （82.0%vs. 21.3%in PM group, P 〈 0.001）. The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group （PM group 14.8%, ABL group 2.0%, P=0.020）.The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.

关 键 词：心房颤动 导管消融 起搏器 窦房结功能不全 

分 类 号：R541.7[医药卫生—心血管疾病]