射频导管消融联合左心耳封堵治疗非瓣膜性心房颤动的随访结果  

Follow-up results of radiofrequency catheter ablation combined with left atrial appendage closure in the treatment of non-valvular atrial fibrillation

作　　者：董艳 任继来 王学成 郑伟[1] 陈铳铳 周秀娟[1] 张凤祥[1] 杨兵 曹克将[1] Dong Yan;Ren Jilai;Wang Xuecheng;Zheng Wei;Chen Chongchong;Zhou Xiujuan;Zhang Fengxiang;Yang Bing;Cao Kejiang(Department of Cardiology,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Cardiology,East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,210029 [2]同济大学附属东方医院心血管内科,上海200120

出　　处：《中华心律失常学杂志》2021年第6期504-509,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨非瓣膜性心房颤动(房颤)患者射频导管消融联合左心耳封堵(一站式)治疗的远期疗效与安全性。方法回顾性分析2016年8月至2018年9月在南京医科大学第一附属医院成功行射频导管消融联合左心耳封堵一站式治疗的症状性房颤患者。采用心电图、24 h动态心电图、经食管超声心动图(TEE)和心脏CT成像(CCTA)对患者进行定期检查,随访其治疗效果与不良事件[房性心律失常复发、缺血性脑卒中/短暂性脑缺血发作(TIA)、装置周围残余分流及装置相关性血栓等]。结果本研究共纳入57例房颤患者,年龄(67.5±8.4)岁,男34例,女23例。其中阵发性房颤39例(68.4%,39/57),非阵发性房颤18例(31.6%,18/57)。CHA2DS2-VASc评分(4.3±1.4)分,Watchman封堵器21例(36.8%,21/57),Amplatzer Cardiac Plug(ACP)封堵器36例(63.2%,36/57)。随访(45.2±6.9)个月,房性心律失常复发15例(26.3%,15/57)。缺血性脑卒中/TIA事件3例(5.3%,3/57),年发生率为1.5%。4例患者死亡,其中2例死于缺血性脑卒中,另2例为非心源性死亡。无大出血事件发生。术后3、6和12个月TEE/CCTA随访率分别为96.5%(55/57)、56.1%(32/57)和36.8%(21/57);封堵装置周围残余分流检出率分别为7.3%(4/55)、6.3%(2/32)和4.8%(1/21)。除1例患者术后3个月CCTA检查发现有5.2 mm的残余分流外,其余残余分流均<3 mm。1例患者植入ACP封堵器后3个月TEE检查发现有装置相关性血栓。结论对于脑卒中风险高的症状性非瓣膜性房颤患者,射频导管消融联合左心耳封堵一站式手术显示较好的远期有效性和安全性。Objective To evaluate the long-term efficacy and safety of radiofrequency catheter ablation combined with left atrial appendage closure(one-stop procedure)in patients with non-valvular atrial fibrillation(NVAF).Methods The retrospective study enrolled NVAF patients who underwent radiofrequency catheter ablation combined with left atrial appendage closure in the First Affiliated Hospital with Nanjing Medical University from August 2016 to September 2018.Electrocardiogram,24 h dynamic electrocardiogram,transesophageal echocardiography(TEE),and cardiac computed tomography angiography(CCTA)were performed at regular follow-up to evaluate the efficacy and safety[the recurrence of atrial arrhythmia,ischemic stroke/transient ischemic attack(TIA),peri-device residual flow and device-related thrombus].Results A total of 57 patients were included in this study.The mean age was(67.5±8.4)years(34 males,23 females).There were 39(68.4%,39/57)patients with paroxysmal atrial fibrillation(AF)and 18(31.6%,18/57)patients with non-paroxysmal AF.Mean CHA2DS2-VASc score was 4.3±1.4.Twenty-one(36.8%,21/57)Watchman devices and 36(63.2%,36/57)Amplatzer Cardiac Plug(ACP)devices were implanted.With a mean follow-up of(45.2±6.9)months,the recurrence of atrial arrhythmia was recorded in 15(26.3%,15/57)patients.Ischemic stroke/TIA occurred in 3(5.3%,3/57)patients with an annual incidence of 1.5%.Four patients died,two of whom died of ischemic stroke,and the others died of non-cardiac deaths.No major bleeding event was encountered.At 3-month,6-month and 12-month TEE/CCTA follow-up examinations,the follow-up rate was 96.5%(55/57),56.1%(32/57)and 36.8%(21/57),respectively.The detection rate of peri-device residual flow was 7.3%(4/55)、6.3%(2/32)and 4.8%(1/21),respectively.The residual flow was less than 3 mm in all patients except for one patient who had a residual flow of 5.2 mm in 3-month CCTA examination.One case of device-related thrombus with ACP occluder was detected in 3-month TEE examination.Conclusion The combined therapy of radiofre

关 键 词：心房颤动 射频导管消融 左心耳封堵 一站式 

分 类 号：R541.75[医药卫生—心血管疾病]