导管消融对阵发性房颤相关快-慢综合征起搏器适应证的影响  

Catheter ablation of atrial fibrillation in patients with paroxysmal atrial fibrillation related Tachycardia-bradycardia syndrome

作　　者：郭炜华[1] 马长生[1,2] 陈英伟[2] 李莉[1] 李超[1] 

机构地区：[1]首都医科大学附属北京同仁医院,北京100005 [2]首都医科大学附属北京安贞医院,北京100029

出　　处：《中国医刊》2015年第10期51-56,共6页Chinese Journal of Medicine

摘　　要：目的阵发性房颤终止后出现的症状性长间歇往往需要植入永久性心脏起搏器,本研究旨在评估导管消融对该类患者的疗效。方法连续入选2010年1月至2012年6月在北京安贞医院住院治疗的阵发性房颤合并房颤终止后症状性长间歇的患者作为研究对象,43例患者进行了导管消融(导管消融组),57例患者进行了永久性起搏器植入(起搏器组)。根据相关指南推荐,所有进行导管消融的43患者术前均为起搏器植入的Ⅰ类指征,随访消融前后评估起搏器指征,消融组随访观察导管消融的效果,此外,术前及随访(20.1±9.6)个月后再次进行起搏器指征评估,发现41例患者不再具备起搏器植入的指征(Ⅲ类指征)。结果随访结束时,两组之间总体心脏原因再住院率无差异(P=0.921);起搏器植入组服用抗心律失常药物比例显著高于导管消融组(起搏器组40.4%,导管消融组4.7%,P<0.001),然而导管消融组窦性心律维持率显著高于起搏器治疗组(导管消融组83.7%,起搏器组21.1%,P<0.001)。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;大多数这类患者经导管消融手术成功根治房颤后避免了起搏器的植入。Objective Symptomatic prolonged sinus pauses on termination of atrial fibrillation（ AF） are an accepted indication for pacemaker implantation. We evaluated the outcome of AF ablation in patients with paroxysmal AF-related tachycardia-bradycardia syndrome and compared the efficacy of catheter ablation with permanent pacing plus anti-arrhythmic drugs（ AADs）. Method Patients with prolonged symptomatic sinus pauses on termination AF were retrospectively analyzed. Forty-three consecutive patients who underwent catheter ablation（ ABL group） were compared to 57 patients who underwent permanent pacing plus AADs（ PM group）. All 43 patients in the ABL group fulfilled Class Ⅰ indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation after（ 20. 1 ± 9. 6） months of follow-up showed that 41 patients did no longer need a pacemaker because of being AF-free with no recurrent symptoms of prolonged sinus pause（ Class Ⅲ indication）. Result Total cardiac-related re-hospitalization was not significantly different between the two groups. More patients in the PM group were on AADs（ PM 40. 4%,ABL 4. 7%,P 0. 001）,while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up（ 83. 7%,vs 21. 1% in PM group,P 0. 001）. Conclusion 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[医药卫生—心血管疾病]