心房颤动导管消融与药物治疗效果的比较研究  

Comparison of catheter ablation and antiarrhythmic drug therapy for atrial fibrillation

作　　者：徐新娜[1] 张萍[1] 李学斌[1] 李鼎[1] 王龙[1] 吴寸草[1] 段江波[1] 昃峰[1] 郭飞[1] 郭继鸿[1] 

机构地区：[1]北京大学人民医院心内科,100044

出　　处：《中国心血管杂志》2015年第2期95-100,共6页Chinese Journal of Cardiovascular Medicine

基　　金：心房颤动治疗规范与技术优化研究(D111100003011006)~~

摘　　要：目的 比较心房颤动（房颤）导管消融治疗与药物治疗的治疗效果。方法 连续入选644例房颤患者,获取基线特征,应用倾向评分方法进行匹配分组,获得两组不同治疗策略的入选人群（257例）,进行为期约18个月的随访,通过Cox比例风险模型比较导管消融和药物治疗对房颤患者一级终点房颤复发事件以及二级终点因心力衰竭住院率、血栓栓塞事件、累积生存率及生活质量改善的影响。结果 （1）无房颤复发终点：导管消融术组优于抗心律失常药物治疗组（HR：3.12,95%CI：1.93~5.03,P〈0.01）。（2）因心力衰竭住院率：导管消融术组与抗心律失常药物治疗组差异无统计学意义（HR：1.14,95%CI：0.67~1.94,P=0.34）。（3）血栓栓塞事件发生率：在导管消融术组和抗心律失常药物治疗组间差异无统计学意义（HR：0.98,95%CI：0.44~2.20,P=0.38）。（4）累积生存率：两组间差异无统计学意义（HR：1.05,95%CI：0.33~3.32,P=0.73）。（5）生活质量评分：抗心律失常药物组生活质量无明显改善,而导管消融术组仅对精神方面评分有显著改善（随访3个月和12个月均为P=0.04）。结论 导管消融治疗与药物治疗相比,房颤复发率更低,并可以改善精神方面的生活质量,但未能降低因心力衰竭住院率和血栓栓塞事件发生的风险,两种治疗手段的累积生存率差异无统计学意义。Objective To compare the clinical efficacy between catheter ablation and antiarrhythmic drug therapy in patients with atrial fibrillation （ AF）. Methods Six hundred and forty-four patients with atrial fibrillation were enrolled. The basic data were collected,and the patients were matched and grouped in two with different treatment strategies according to propensity score method （257 patients for each）. The follow-up period was 18 months. The effectiveness of catheter ablation and antiarrhythmic drug therapy was compared via the Cox proportional hazards model. The primary endpoint was recurrence of atrial fibrillation. The secondary endpoints were hospitalization rate due to aggravating heart failure, the incidence of thromboembolism, the cumulative survival rate and the improvement of life quality. Results 1. The recurrence rate of atrial fibrillation was lower in catheter ablation group than in antiarrhythmic drug group （HR：3. 12, 95% CI：1. 93 - 5. 03,P 〈 0. 01） . 2. There was no significant difference between the two groups in the hospitalization rate due to heart failure （HR：1. 14,95% CI：0. 67 - 1. 94,P = 0. 34）. 3. There was no significant difference between the two groups in the incidence of thromboembolism event （HR：0. 98,＆amp;nbsp;95% CI：0. 44 - 2. 20,P = 0. 38） . 4. There was no significant difference between the two groups in the cumulative survival rate （ HR： 1. 05, 95% CI： 0. 33 - 3. 32, P = 0. 73 ） . 5. There was no significant improvement in quality of life in antiarrhythmic drug group, whereas there was significant improvement of mental health score in catheter ablation group （P = 0. 04 for the 3rd month, P = 0. 04 for the 12th month）. Conclusions Compared with the antiarrhythmic drug group, there is lower recurrence of atrial fibrillation in the catheter ablation group, and better mental quality as well. However, there is no significant difference of hospitalization rate due to heart failure, thromboembolism event and cumulative survival rate between

关 键 词：心房颤动 导管消融术 抗心律失常药 

分 类 号：R541.75[医药卫生—心血管疾病]