二代球囊冷冻消融治疗80岁及以上高龄老年心房颤动的临床研究  

Efficacy and safety of second-generation cryoballoon ablation on the elderly patients aged 80 years and over with atrial fibrillation

作　　者：连亮华[1] 平欢欢 张建成[1] 吴梅琼[1] 林亚洲[1] 陈林[1] LIAN Lianghua;PING Huanhuan;ZHANG Jiancheng;WU Meiqiong;LIN Yazhou;CHEN Lin(Department of Cardiology,Fujian Provincial Hospital,Provincial Clinical Medicine College of Fujian Medical University,Fuzhou,350001,China;Department of Cardiology,Fuding City Hospital)

机构地区：[1]福建医科大学省立临床学院福建省立医院心内科,福州350001 [2]福鼎市医院心内科

出　　处：《临床心血管病杂志》2023年第11期845-849,共5页Journal of Clinical Cardiology

摘　　要：目的:评价二代冷冻球囊消融术治疗高龄老年心房颤动(房颤)的有效性和安全性,分析术后复发情况及其影响因素。方法:回顾性分析2017年4月—2020年4月在福建省立医院接受二代冷冻球囊消融治疗的60岁及以上阵发性房颤患者237例,分为高龄组(≥80岁,32例)和普通组(60~79岁,205例)。收集患者术前临床资料和术后1年随访资料,比较两组术后不良事件发生率及房颤复发率的差异。采用二分类logistic回归分析术后复发的影响因素。结果:与普通组比较,高龄组CHA_(2)DS_(2)-VASc评分更高,左心房内径更大(均P<0.05)。高龄组和普通组术后不良事件发生率(9.38%vs 3.41%)以及术后3个月(12.50%vs 7.39%)、6个月(19.35%vs 12.50%)、9个月(23.33%vs 15.98%)、12个月(28.57%vs 17.89%)的复发率比较均差异无统计学意义。Logistic回归分析显示,房颤病程(OR=1.013,95%CI:1.004~1.022)、糖尿病(OR=18.412,95%CI:3.661~92.599)、左心房内径(OR=16.861,95%CI:4.506~63.086)是房颤二代球囊冷冻消融术后复发的影响因素(均P<0.05)。结论:80岁及以上的高龄房颤患者接受二代球囊冷冻消融术治疗的有效性和安全性与60~79岁年龄组老年患者无明显差异。病程长、糖尿病和左心房内径增加是老年房颤患者术后复发的危险因素。Objective:To evaluate the efficacy and safety of second-generation cryoballoon ablation(CBA) on elderly patients with paroxysmal atrial fibrillation(PAF),and analyze influencing factors of postoperative recurrence.Methods:A total of 237 elderly patients(≥60 years) with PAF who underwent CBA in Fujian Provincial Hospital from April 2017 to April 2020 were retrospectively analyzed.The overage group(≥80 years,n=32) and the aged group(60-79 years,n=205) were classified according to age.The clinical data of preoperation and postoperation1 in 1-year follow-up were collected,and the incidence of postoperative adverse events and AF recurrence between the two groups were compared.Logistic regression analysis was used to analyze the influencing factors of postoperative recurrence.Results:CHA_2DS_2-VASc score and left atrial diameter(LAD) in the overage group were significantly higher than those in the aged group(both P<0.05).Logistic regression analysis showed that the course of atrial fibrillation(OR=1.013,95%CI:1.004-1.022),diabetes(OR=18.412,95%CI:3.661-92.599),LAD(OR=16.861,95%CI:4.506-63.086) were risk factors for AF recurrence after CBA(all P<0.05).There was no statistically significant difference in the incidence of postoperative adverse events between the overage group and the aged group(9.38% vs 3.41%),as well as the recurrence rates at 3 months(12.50% vs 7.39%),6 months(19.35% vs 12.50%),9 months(23.33% vs 15.98%),and 12 months(28.57% vs 17.89%) after surgery.Conclusion:The efficacy and safety of second-generation CBA in patients aged 80 years and over with AF are not significantly different from those of patients aged 60-79 years.Prolonged course of disease,diabetes,and LAD are risk factors for post-operation AF recurrence in elderly patients.

关 键 词：心房颤动 球囊冷冻消融 老年 

分 类 号：R541.7[医药卫生—心血管疾病]