房间隔缺损并发的心房颤动的治疗探讨  

The treatment of atrial fibrillation with atrial septal defect

作　　者：潘子磊 杨荣[1] 孔祥清[1] 盛燕辉[1] 张浩[1] 孙伟[1] 张海峰[1] 雍永宏[1] 杨悉微 陈明龙[1] 杨兵[1] 张凤祥[1] 居维竹[1] 

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏南京210029 [2]南京外国语学校,江苏南京210008

出　　处：《南京医科大学学报（自然科学版）》2015年第5期674-677,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金资助(30901473)

摘　　要：目的 :探讨房间隔缺损(atrial septal defect,ASD)并发的心房颤动(atrial fibrillation,AF)的临床特点和治疗AF的不同方法的效果。方法:分析641例行ASD封堵术患者的AF发生率和危险因素,比较药物或者导管消融治疗AF的疗效。结果:641例ASD患者的AF发生率为4.8%,其中年龄≥40岁的AF发生率为8.4%,年龄≥60岁的患者的AF发生率高达25%。与无AF的患者相比,AF者中男性多见、年龄大、右心房平均压力高、肺动脉平均压力高、左心房内径大、左室舒张末内径大以及左室射血分数低,进一步分析发现,男性、年龄≥40岁和左房内径增大是ASD并发AF的高危因素。AF转复及维持窦性心律治疗,导管射频消融优于药物治疗。结论:ASD患者中AF的发生率高于正常人群,男性、年龄≥40岁和左房内径增大是ASD并发AF的高危因素,导管射频消融在AF转复及维持窦性心律治疗上优于药物。Objective：To analyse the clinical feature of atrial fibrillation（AF） with secundum atrial septal defect（ASD） and the outcomes of different treatment methods of AF. Methods：To calculate the incidence of AF in 641 patients with ASD before transcathter closure. And to find the risk factors in the patients with AF. To compare the outcomes between cardioversion of AF with catheter ablation and with antiarrhythmic drug therapy. Result：The incidence of AF was 4.8% in 641 patients with ASD, 8.4% in patients above 40 years old and 25% in patients above 60 years old. Compared with the patients without AF,the patients suffering AF were characterized by much more males, higher pressure of fight atrium, higher pressure of pulmonary,larger diameter of left atrium, larger left ventricular end diastolic diameter and lower left ventricular ejection fraction. Male,aged above 40 years old and larger diameter of left atrium were identified as risk factors for AF in ASD patients. The rate of eardioversion of AF with catheter ablation was higher than that of antiarrhythmic drug therapy. Conclusion：The incidence of AF was high in patients with ASD. Male,aged above 40 years old and larger diameter of left atrium were identified as risk factors for AF in ASD patients. Catheter ablation of AF should be a effective method for treatment of AF with ASD.

关 键 词：房间隔缺损 心房颤动 治疗 

分 类 号：R541.1[医药卫生—心血管疾病]