导管射频消融治疗老年心房颤动单中心经验  

Experience with radiofrequency catheter ablation of elderly AF patients in a single center

作　　者：李世兴 时向民[1] 李健[1] 单兆亮[1] 郭红阳[1] 苑洪涛[1] 林琨[1] 国建萍[1] 王玉堂[2] Li Shixing;Shi Xiangmin;Li Jian;Shan Zhaoliang;Guo Hongyang;Yuan Hongtao;Lin Kun;Guo jianping;Wang Yutang(Department of Cardiology,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院心血管病医学部,北京100853 [2]解放军总医院第二医学中心心血管内科

出　　处：《中华老年心脑血管病杂志》2021年第7期676-679,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：全军保健专项课题(18BJZ40);全军医学科技青年培育计划(17QNP035)。

摘　　要：目的总结单中心导管射频消融治疗老年心房颤动(房颤)患者的经验。方法入选2018年1月~2019年9月于本中心导管射频消融治疗老年房颤患者122例,完善相关检查。术中针对不同心律失常采取对应消融策略。结果122例患者合并疾病(2.4±1.1)种,N末端B型钠尿肽前体(821±235)μg/L,左心房前后径(40.2±5.3)mm,左心耳血流速度(0.40±0.18)m/s。CHA2DS2-VASc评分(2.1±1.2)分,HAS-BLED评分(1.1±0.8)分。86例需抗凝治疗患者中34.9%正确使用抗凝药物。16.4%患者存在左心房纤维化。术中房颤外心律失常发生率19.7%,均采取对应的消融策略取得成功。采用导管射频消融联合经皮左心耳封堵“一站式”手术11例(9.0%)。术后1年随访单次导管射频消融术成功率为83.6%,无严重并发症。结论老年房颤患者合并疾病多,左心房纤维化比例高,导管消融治疗需要个体化策略,安全有效。Objective To summarize the experience with radiofrequency catheter ablation of elderly AF patients in a single center.Methods One hundred and twenty-two elderly AF patients who underwent radiofrequency catheter ablation in our center from January 2018 to September 2019 were included in this study.Their baseline data,comorbidity,echocardiographic and transesophageal echocardiographic parameters,use of anticoagulant drugs,CHA2DS2-VASc score and HASBLED score were recorded.Certain ablation strategies were taken for arrhythmia during the catheter ablation period.Results The 122 elderly AF patients included in this study were complicated with 2.4±1.1 other diseases,CHA2DS2-VASc score 2.1±1.2 and HAS-BLED score 1.1±0.8.Their left atrial anteroposterior diameter was 40.2±5.3 mm.Their left auricular flow speed was 0.40±0.18 m/s.Those who rationally used the anticoagulant drugs accounted for 34.9%of the 86 elderly AF patients who received anticoagulant therapy.Left atrial fibrosis was diagnosed in 16.4%of the 122 elderly AF patients.The incidence of arrhythmia was 19.7%during the catheter ablation period,which was cured after catheter ablation.One-step radiorequency catheter ablation combined with transcutaneous left auricular blocking was successful in 11 patients(9.0%).The success rate of single radiofrequency catheter ablation was 83.6%with no occurrence of severe complications during the 1-year follow-up period.Conclusion Elderly AF patients are usually complicated with other diseases and a high ratio of left atrial fibrosis,safe and effective individualized catheter ablation should thus be considered for them.

关 键 词：导管消融术 心房颤动 抗凝药 心律失常 心性 

分 类 号：R541.75[医药卫生—心血管疾病]