房颤介入手术中房间隔穿刺后医源性房间隔缺损的临床观察  

Clinical observation of iatrogenic atrial septal defect after atrial septal puncture during atrial fibrillation intervention surgery

作　　者：朱苏文 李小波[1] 刘水源 张风富 周陵[1] 胡作英[1] Zhu Suwen;Li Xiaobo;Liu Shuiyuan;Zhang Fengfu;Zhou Ling;Hu Zuoying(Department of Cardiology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院心内科,南京210006

出　　处：《中国医师杂志》2023年第12期1811-1814,1819,共5页Journal of Chinese Physician

基　　金：江苏省自然科学基金(BK2019412)。

摘　　要：目的观察左心耳封堵(LAAo)及房颤冷冻球囊消融(CBA)术后医源性房间隔缺损(IASD)的发生、闭合情况,并寻找可能影响IASD发生的相关因素。方法回顾性选取2016年6月7日至2020年12月2日于南京医科大学附属南京医院心内科成功行LAAo手术及2016年12月29日至2020年9月10日行房颤CBA手术的患者,共计383例。随访患者术后1个月、3个月、6个月、1年及>1年的超声心动图以判断是否发生IASD,并对两组手术间IASD发生率进行比较,分析有IASD和无IASD两组间临床资料,寻找发生IASD的相关因素。结果房颤CBA术后1个月[73.8%(138/187)vs 47.9%(67/140),P<0.001]、3个月[39.0%(57/146)vs 13.6%(16/118),P<0.001]、6个月[17.7%(22/124)vs 3.6%(4/110),P=0.001]、1年[11.8%(15/127)vs 1.8%(2/112),P=0.003]及1年后[9.8%(13/133)vs 0.9%(1/116),P=0.002]的IASD发生率均显著高于LAAo。与无IASD组相比,IASD组男性占比更少[59.0%(121/205)vs 83.6%(102/122),P<0.001],阵发性房颤占比更高[61.5%(126/205)vs 45.9%(56/122),P=0.006]。Logistic回归分析发现女性和CBA与术后IASD显著相关。结论与LAAo相比,房颤CBA术后IASD发生率较高,部分IASD术后超过1年仍持续存在,女性与IASD显著相关。Objective To observe the occurrence and closure of iatrogenic atrial septal defect(IASD)after left atrial appendage occlusion(LAAo)and atrial fibrillation cryoballoon ablation(CBA),and to identify potential factors that may affect the occurrence of IASD.Methods A total of 383 patients who underwent successful LAAo surgery in the Department of Cardiology at the Nanjing Hospital Affiliated to Nanjing Medical University from June 7,2016 to December 2,2020,and atrial fibrillation CBA surgery from December 29,2016 to September 10,2020 were retrospectively selected.Patients were followed up with echocardiography at 1 month,3 months,6 months,1 year,and>1 year after surgery to determine the occurrence of IASD.The incidence of IASD between the two groups was compared,and clinical data between the two groups with and without IASD were analyzed to identify the relevant factors for the occurrence of IASD.Results One month after CBA surgery for atrial fibrillation[73.8%(138/187)vs 47.9%(67/140),P<0.001],3 months[39.0%(57/146)vs 13.6%(16/118),P<0.001],6 months[17.7%(22/124)vs 3.6%(4/110),P=0.001],1 year[11.8%(15/127)vs 1.8%(2/112),P=0.003],and one year later[9.8%(13/133)vs 0.9%(1/116),P=0.002],the incidence of IASD was significantly higher than those in LAAo.Compared with the non IASD group,the IASD group had a lower proportion of males[59.0%(121/205)vs 83.6%(102/122),P<0.001],and a higher proportion of paroxysmal atrial fibrillation[61.5%(126/205)vs 45.9%(56/122),P=0.006].Logistic regression analysis found a significant correlation between women and CBA with postoperative IASD.Conclusions Compared with LAAo,the incidence of IASD after CBA for atrial fibrillation is higher,and some IASD persist for more than 1 year after surgery.Women are significantly associated with IASD.

关 键 词：房间隔缺损 医源性损伤 左心耳封堵 冷冻球囊消融 

分 类 号：R541.75[医药卫生—心血管疾病]