射频导管消融治疗青年心房颤动患者的疗效分析  

Efficacy of Radiofrequency Catheter Ablation for Atrial Fibrillation in Patients Aged≤45 Years

作　　者：蔡迟[1] 王靖[1] 张妮潇 黄灏 孙旭 华伟[1] 楚建民[1] 张澍[1] CAI Chi;WANG Jing;ZHANG Nixiao;HUANG Hao;SUN Xu;HUA Wei;CHU Jianmin;ZHANG Shu(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),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,北京市100037

出　　处：《中国循环杂志》2022年第5期459-464,共6页Chinese Circulation Journal

摘　　要：目的:分析行射频导管消融治疗的青年(≤45岁)心房颤动(房颤)患者的临床特点,探讨射频导管消融治疗青年房颤患者的临床疗效。方法:回顾性收集于2017年1月至2019年1月在中国医学科学院阜外医院行射频导管消融治疗的358例房颤患者(≤60岁)的临床资料,按年龄分为青年组(≤45岁,n=94)及非青年组(45岁<年龄≤60岁,n=264),比较两组基线临床特点并对其进行随访。手术3个月后,经心电图或动态心电图证实的房颤、心房扑动和(或)房性心动过速发作且持续时间大于30 s定义为房颤复发。结果:青年组房颤患者平均年龄为(39.7±4.8)岁,男性76例(80.9%)。青年组与非青年组相比房颤病程较短[(15.8±15.6)个月vs(.27.5±34.0)个月,P=0.001],CHA2DS2-VASc评分[(0.74±0.83)分vs(.1.19±1.07)分,P<0.001]和HAS-BLED评分[(0.40±0.54)分vs.(0.63±0.65)分,P=0.002]更低,左心房内径更小[(38.2±5.6)mm vs(.40.0±5.4)mm,P=0.006],合并心房扑动比例较高,而心脑血管疾病合并症较低(P<0.05)。青年组患者行三尖瓣峡部线消融比例较高,而左心房后壁BOX线性消融比例较低(P<0.05)。青年组与非青年组患者手术并发症发生率差异无统计学意义(1.1%vs.2.7%,P=0.513)。平均随访(26.5±10.9)个月,青年组房颤单次射频导管消融术后成功率明显高于非青年组(87.2%vs.75.0%,P=0.030)。青年组中阵发性房颤患者与持续性房颤患者射频导管消融成功率均较高,差异无统计学意义(88.1%vs.85.7%,P=0.754)。结论:射频导管消融治疗青年房颤患者成功率较高,且青年阵发性房颤患者与持续性房颤患者射频导管消融成功率均较高。Objectives:To analyze and investigate the clinical profiles and efficacy of radiofrequency catheter ablation for atrial fibrillation(AF)in young patients aged≤45 years.Methods:This study included 358 consecutive AF patients(≤60 years)who underwent radiofrequency catheter ablation at Fuwai Hospital.Patients were divided into group 1:aged≤45 years(n=94)and group 2:45<aged≤60 years(n=264).The clinical characteristics,procedural parameters and complications were compared.All patients were followed-up at least 3 months post catheter ablation.Patients with the presence of episodes of AF/atrial tachycardia lasting more than 30 seconds after a 3-month blanking period were classified as AF recurrence.Results:The mean age of patients in group 1 was(39.7±4.8)years and 76 patients(80.9%)were male.Compared to patients in group 2,patients in group 1 were presented with shorter AF history([15.8±15.6]months vs.[27.5±34.0]months),lower CHA2DS2-VASc score(0.74±0.83 vs.1.19±1.07)and HAS-BLED score(0.40±0.54 vs.0.63±0.65),smaller left atrial dimension([38.2±5.6]mm vs.[40.0±5.4]mm),higher incidence of atrial flutter,and lower incidence of comorbidities.During the procedure,more cavotricuspid isthmus ablation and less left atrial posterior wall box ablation were performed in patients in group 1.There was no significant difference in complications rate between the two groups.After a mean follow-up of(26.5±10.9)months,the overall success rate was 87.2%in group 1,which was significantly higher than that in group 2(75.0%,P=0.030).In subgroup analysis,the overall success rates were similar between paroxysmal and persistent atrial fibrillation patients in group 1.Conclusions:Regardless of paroxysmal and persistent atrial fibrillation,radiofrequency catheter ablation for AF is more effective in young patients aged≤45 years as compared to patients 45<aged≤60 years old.

关 键 词：射频导管消融 心房颤动 青年 临床特点 疗效 

分 类 号：R54[医药卫生—心血管疾病]