既往颅内出血合并心房颤动的导管消融治疗  

Efficacy and safety of catheter ablation in atrial fibrillation patients with prior intracranial hemorrhage

作　　者：郭雪原[1] 董建增[1] 龙德勇[1] 喻荣辉[1] 汤日波[1] 白融[1] 刘念[1] 桑才华[1] 蒋晨曦[1] 李松南[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国介入心脏病学杂志》2016年第7期375-378,共4页Chinese Journal of Interventional Cardiology

基　　金：科技部国际合作项目(2013DFB30310)

摘　　要：目的评价既往颅内出血的心房颤动患者接受导管消融的安全性和有效性。方法连续入选2007年1月至2014年12月在北京安贞医院接受心房颤动导管消融且既往有颅内出血病史的患者22例。所有患者接受导管消融治疗,围术期采取停用华法林,应用低分子肝素抗凝。随访术后心律失常复发情况和临床预后。结果所有患者围术期均未发生严重出血或栓塞事件。1例患者术后发生心脏压塞,2例患者出现血管并发症。平均随访(28.9±10.7)个月,15例(68.2%)患者初次消融后维持窦性心律,2例(9.1%)复发患者接受再次消融后成功维持窦性心律,总体窦性心律维持率77.3%。所有患者术后均停用华法林,随访期间无栓塞和出血事件发生。结论既往有颅内出血病史的心房颤动患者接受导管消融是安全有效的,术后维持窦性心律可避免抗凝药物使用带来的出血风险。Objective To determine the efficacy and safety of catheter ablation of atrial fibrillation in patients with a prior history of intracranial hemorrhage （ICH）.Methods Between January 2007 and December 2014,a total of 22 patients with AF and prior ICH were recruited.All patients underwent catheter ablation and were followed up for assessment of maintenance of sinus rhythm （SR） and clinical outcomes.Results No patient suffered from stroke and systemic embolism during perioperative period.One patient developed cardiac temponade and 2 patients had other vascular complications after ablation.After a mean followup of （28.9 ± 10.7） months,15 patients （68.2％） remained in SR after initial ablation and 2 patients （9.1％）maintained SR after repeated ablation.Total SR maintainence rate was 77.3％.All patients who maintained SR discontinued warfarin treatment and no thromboembolic or bleeding events occurred during follow-up.Conclusions Catheter ablation is effective and safe in the management of AF patients with prior ICH.

关 键 词：心房颤动 导管消融 颅内出血 抗凝治疗 

分 类 号：R541.75[医药卫生—心血管疾病]