中国心房颤动介入治疗现况与质量分析  

Current status and quality analysis of interventional therapy for patients with atrial fibrillation in China

作　　者：胡志成[1] 蒋超[2] 刘尚雨 张子末 张帅 范思洋[1] 郑黎晖[1] 马长生[2] 姚焰[1] Hu Zhicheng;Jiang Chao;Liu Shangyu;Zhang Zimo;Zhang Shuai;Fan Siyang;Zheng Lihui;Ma Changsheng;Yao Yan(Cardiac Arrhythmia Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院,心律失常中心,100037 [2]首都医科大学附属北京安贞医院心血管内科,100029

出　　处：《中华心血管病杂志》2021年第3期224-228,共5页Chinese Journal of Cardiology

摘　　要：目的描述我国心房颤动(房颤)介入治疗的现况并对医疗质量开展分析。方法在全国7大区域中分别选取1~3家区域医学中心,按比例随机抽取各中心2017年全年行房颤介入治疗(导管消融术及左心耳封堵术)的住院病历,收集CHA2DS2-VASc评分记录、导管消融术后抗凝、是否符合左心耳封堵术适应证等情况,并分析当次住院期间介入治疗相关并发症和严重并发症。结果17家中心2017年共行房颤导管消融术10800例、左心耳封堵术447例。10/17中心房颤导管消融手术量<500例,7/17中心左心耳封堵手术量<20例。共抽取行导管消融术和左心耳封堵术病历1347和160份。15.8%(238/1505)的非瓣膜性房颤患者病历中记录了CHA2DS2-VASc评分。房颤导管消融术后抗凝率为98.6%(1328/1347),16/17的中心抗凝率高于90%;导管消融术的并发症和严重并发症发生率分别为0.9%(12/1347)和0.4%(5/1347);导管消融手术量<500例的中心并发症以及严重并发症发生率与手术量≥500例的中心差异无统计学意义[0.5%(2/413)比1.1%(10/934),P>0.05;0.5%(2/413)比0.3%(3/934),P>0.05]。左心耳封堵适应证符合率为81.3%(130/160),其中手术量≥20例的中心符合率高于手术量<20例的中心[84.8%(106/125)比68.6%(24/35),P<0.05];左心耳封堵术的并发症和严重并发症发生率分别为3.1%(5/160)和1.9%(3/160),左心耳封堵手术量<20例的中心并发症发生率高于手术量≥20例的中心[8.6%(3/35)比1.6%(2/125),P<0.05],严重并发症发生率差异无统计学意义[5.7%(2/35)比0.8%(1/125),P>0.05]。结论我国房颤介入治疗总体规范且安全,并发症总体发生率较低、导管消融术后抗凝比例高、左心耳封堵术适应证符合率总体尚可,但上述指标在不同中心差异大。Objective To define the current status and analyze the medical quality of interventional therapy for patients with atrial fibrillation(AF)in China.Methods This survey was performed in all seven large regions of China,one to three regional major medical centers were selected from each region.Medical records of patients underwent interventional therapy for AF in the year 2017 were randomly inspected.CHA2DS2-VASc score,prescribed anticoagulant after ablation,indication of left atrial appendage occlusion(LAAO),and complications in the medical records were analyzed.Results A total of 10800 AF catheter ablations and 447 LAAOs were performed in 17 regional medical centers in 2017.There were 10/17 centers performing AF catheter ablation<500 cases and 7/17 centers performing LAAO<20 cases.A total of 1347 cases of catheter ablation and 160 cases of LAAO were selected for further analysis.Among all selected cases,15.8%(238/1505)non-valvar AF cases recorded CHA2DS2-VASc scores.The anticoagulation rate after AF catheter ablation was 98.6%(1328/1347),anticoagulation rate was higher than 90%in 16 out of 17 centers.The complication and severe complication rates of AF catheter ablation were 0.9%(12/1347)and 0.4%(5/1347),respectively.The differences of complication and severe complication rates in AF catheter ablation were similar between centers performing<500 cases and centers performing≥500 cases(0.5%(2/413)vs.1.1%(10/934),P>0.05;0.5%(2/413)vs.0.3%(3/934),P>0.05).The coincidence rate of LAAO indication was 81.3%(130/160),and the rate was higher in center performing≥20 cases than in centers performing<20 cases(84.8%(106/125)vs.68.6%(24/35),P<0.05).The complication and severe complication rates of LAAO were 3.1%(5/160)and 1.9%(3/160).The rate of complications in LAAO was higher in center performing<20 cases than in centers performing≥20 cases(8.6%(3/35)vs.1.6%(2/125),P<0.05),and there was no significant difference in severe complication rate(5.7%(2/35)vs.0.8%(1/125),P>0.05).Conclusions Interventional therapy for AF in China

关 键 词：心房颤动 介入治疗 医疗质量 

分 类 号：R541.75[医药卫生—心血管疾病]