经皮左心耳封堵联合射频消融对持续性心房颤动患者的有效性和安全性及消融复发率的影响  

Safety,efficacy and recurrence rate of the left atrial appendage closure combined with catheter ablation for persistent atrial fi brillation

作　　者：杨婧[1] 张孝鸿 尤玲[1] 张艳[1] 刘倩[1] 张光明[1] 耿雪[1] 尹磊 谢瑞芹 YANG Jing;ZHANG Xiao-hong;YOU Ling;ZHANG Yan;LIU Qian;ZHANG Guang-ming;GENG Xue;YIN Lei;XIE Rui-qin(Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心内科,河北石家庄050000

出　　处：《中国介入心脏病学杂志》2023年第5期321-327,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨持续性心房颤动(房颤)患者在射频消融的基础上加行经皮左心耳封堵术的有效性和安全性及对消融复发率的影响。方法纳入2015年4月至2018年10月在河北医科大学第二医院心内科行射频消融及Watchman左心耳封堵一站式手术的非瓣膜性持续性房颤患者66例(一站式组),以及同期在本中心接受射频消融的持续性房颤患者174例(射频消融组)。经1︰1倾向性评分匹配后,两组各有65例患者纳入分析。比较两组临床特征、围术期与随访期间主要不良事件发生率以及房颤复发率。结果两组患者临床基线资料比较,差异均无统计学意义(均P>0.05)。两组均成功进行了环肺静脉电隔离,术后均为窦性心律。一站式组患者均成功置入Watchman封堵器,在3个月的经食管超声心动图随访中1例患者出现器械相关血栓。在12个月的随访中,一站式组出现2例出血事件,射频消融组1例患者在房颤消融后3个月出现脑出血。两组术后不良事件的发生率比较,差异均无统计学意义(均P>0.05)。Kaplan-Meier生存曲线显示,在3个月的空白期内,两组的早期事件发生率比较,差异无统计学意义(P=0.224);在12个月的随访中,一站式组房颤复发率与射频消融组相比,差异无统计学意义(27.7%比24.6%,P=0.984)。多因素Cox回归分析显示,在空白期(HR 1.44,95%CI 0.72~2.86,P=0.300)或长期随访期(HR 0.95,95%CI 0.47~1.90,P=0.876)均没有确定不同术式与早期事件及房颤复发之间的关联。结论射频消融及Watchman左心耳封堵一站式手术治疗房颤是安全有效的,但在射频消融的基础上,加行左心耳封堵对持续性房颤的消融复发率并无影响。Objective The purpose of this study was to investigate the effect of safety,efficacy and the recurrence rate of the combined produre of left atrial appendage closure on the basis of catheter ablation of persistent atrial fibrillation,and to provide evidence for the optimal treatment of persistent atrial fibrillation.Methods In this study,the study population comprised 66 consecutive patients who underwent combined AF ablation and Watchman LAAC(combined therapy group)in our center,and 174 participants of the AF simple catheter ablation group.They were matched using propensity score matching and 65 paris of patients were selected.Clinical characteristics,periprocedural adverse events,long-term observational clinical outcomes including the major adverse cardiac and cerebrovascular event incidence and AF recurrence rate were evaluated.Results There was no significant difference in clinical characteristics between the two groups(P>0.05).Pulmonary vein isolation was successfully performed in both groups,and all patients were in sinus rhythm postoperatively.In the combined therapy group,the watchman LAAC was successfully implanted.There was no significant difference in the incidence of perioperative complications between the combined therapy and catheter ablation groups(P=0.619).The incidence of stroke and bleeding during postoperative follow-up were not signifi cantly diff erent(Both P>0.05).Kaplan-Meier survival curves indicated that during the fi rst 3 months,there was no signifi cant diff erence between groups in the incidence of early events(P=0.224,Log-rank test).During 12-month of follow-up,18 patients(27.7%)in combined therapy group and 16 patients(24.6%)in simple ablation group had recurrent AF and there was no signifi cant diff erence in the recurrence rate between the two groups(P=0.984,Log-rank test).Multivariate Cox regression analysis showed no association of the diff erent procedures with overall recurrence-free survival.Conclusions Combined therapy is safe and effective in the treatment of atrial fibrill

关 键 词：心房颤动 经皮左心耳封堵 射频消融 复发率 

分 类 号：R541.7[医药卫生—心血管疾病]