射血分数下降与射血分数正常的持续性房颤患者射频手术风险比较  

Comparison of the Risk of Radiofrequency Surgery in Patients with Persistent Atrial Fibrillation with Decreased Ejection Fraction and Normal Ejection Fraction

作　　者：杨美玲 杨建涛 邢亮亮 李静 李婷 巩贵宏 YANG Mei-ling;YANG Jian-tao;XING Liang-liang(Department of Cardiology,The First Affiliated Hospital of Henan University,Kaifeng,Henan,475000,China)

机构地区：[1]河南大学第一附属医院心内科,河南开封475000

出　　处：《黑龙江医学》2023年第11期1295-1298,共4页Heilongjiang Medical Journal

摘　　要：目的:比较射血分数下降与射血分数正常的持续性房颤患者射频手术风险。方法:收集2015年2月—2018年2月河南大学第一附属医院收治的200例持续性房颤患者作为研究对象。根据术前左室射血分数(LVEF)值分为A组(LVEF<40%)、B组(LVEF40%~49%)、C组(LVEF≥50%)。由同一位医师采用三维电解剖标测系统(CARTO)三维标测下完成射频消融术。比较三组患者左心房建模时间、消融时间、总手术时间、术中发生急性心衰、其他房性心律失常(RATs)、脑血管事件、心包积液事件例数及平均住院日。结果:三组患者左心房建模时间、消融时间、总手术时间比较,差异无统计学意义(P>0.05)。A组与B组平均住院日长于C组,差异有统计学意义(P<0.05)。双侧肺静脉前庭电隔离后仍为房颤律,给予直流电复律,三组患者术中需要电复律例数比较,差异无统计学意义。A组术中发生RATs 3例,其中,1例为房速,2例为房扑。B组发生1例房速,C组发生3例房速。A组与B组、A组与C组组间比较,差异有统计学意义(P<0.05)。B组与C组组间比较,差异无统计学意义(P>0.05)。A组术中心衰急性发作5例,B组急性心衰4例,C组无急性心衰发生。A组与B组组间比较,差异有统计学意义(P<0.05)。A组术中发生脑血管事件1例,B组与C组术中无脑血管事件发生。三组患者均无心包积液或填塞事件发生。持续性房颤射频术中可发生RATs、心衰急性发作、脑血管事件发生,但总发生率不高。结论:LVEF<40%的持续性房颤患者导管射频术后心脏结构及功能改善,可从射频消融术中获益,但术中发生急性心衰、RATs、脑血管事件的风险相对较高。Objective:To compare the risk of radiofrequency surgery in patients with persistent atrial fibrillation with de⁃creased ejection fraction versus normal ejection fraction.Methods:200 patients with persistent atrial fibrillation admitted to the hospital from February 2015 to February 2018 were collected as the study population.According to the preoperative left ventricular ejection fraction(LVEF)values,they were divided into group A(LVEF<40%),group B(LVEF 40%-49%),and group C(LVEF≥50%).Radiofrequency ablation was performed by the same physician with a three-dimensional electroanatomical landmarking sys⁃tem(CARTO).The time to left atrial modeling,ablation time,total procedure time,number of cases of intraoperative acute heart failure,other atrial arrhythmias(RATs),cerebrovascular events,pericardial effusion events,and mean hospital stay were compared among the three groups of patients.Results:The differences were not statistically significant when comparing the modeling time,ablation time,and total procedure time of the left atrium in the three groups(P>0.05).The mean hospital stay was longer in group A and group B than in group C,and the differences were statistically significant(P<0.05).Bilateral pulmonary vein vestibules re⁃mained in atrial fibrillation rhythm after electrical isolation,and DC electrical resuscitation was given.There was no statistically sig⁃nificant difference in the number of cases requiring intraoperative electrical resuscitation in the three groups of patients compared(P>0.05).3 cases of RATs occurred intraoperatively in group A,among which,one case was atrial tachycardia and two cases were atrial flutter,one case of atrial tachycardia occurred in group B,and three cases of atrial tachycardia occurred in group C.The difference was statistically significant when comparing group A with group B and group A with group C(P<0.05).The differ⁃ence was not statistically significant when comparing group B with group C(P>0.05).There were 5 cases of acute episodes of heart failure in group A,

关 键 词：持续性房颤 左心室射血分数 射频消融术 

分 类 号：R54[医药卫生—心血管疾病]