经皮左心耳封堵联合射频消融对持续性心房颤动患者脑钠肽分泌的影响  

Effect of left atrial appendage closure combined with catheter ablation on brain natriuretic peptide levels in patients with persistent atrial fibrillation

作　　者：杨婧[1] 尤玲[1] 王连霞 张艳[1] 尹磊 张光明[1] 邢航航 谢瑞芹 YANG Jing;YOU Ling;WANG Lianxia;ZHANG Yan;YIN Lei;ZHANG Guangming;XING Hanghang;XIE Ruiqin(First Department of Cardiology,The Second Hospital of Hebei Medical University,Shijiazhuang 050004,China)

机构地区：[1]河北医科大学第二医院心内一科,石家庄050004

出　　处：《国际心血管病杂志》2024年第2期118-122,共5页International Journal of Cardiovascular Disease

摘　　要：目的:探讨经皮左心耳封堵联合射频消融术对持续性心房颤动(房颤)患者脑钠肽(BNP)分泌的影响。方法:2015年4月至2018年10月连续纳入非瓣膜性持续性房颤患者240例,其中行经皮左心耳封堵联合射频消融术(一站式组)66例,行单纯射频消融术(射频消融组)174例,根据性别、年龄、CHA2DS2-VASc和HAS-BLED评分行倾向性评分1︰1匹配。2组患者在术前,术后1 d、2 d、3 d、3个月、12个月时取静脉血行BNP测定。结果:根据倾向性评分,共入组65对匹配患者。2组患者成功行环肺静脉隔离术,一站式组均成功植入Watchman封堵器,术后患者均转为窦性心律。一站式组患者术后1、2 d时BNP水平较基线明显下降,术后3 d时升高,与术前差异无统计学意义,术后3个月较术前明显下降[(102±138)ng/L对(256±181)ng/L,P<0.001],1年时BNP水平呈持续下降趋势[(66±53)ng/L对(256±181)ng/L,P<0.001]。射频消融组患者的BNP水平也观察到相同的趋势。2组间BNP水平的差异无统计学意义。结论:经皮左心耳封堵联合射频消融显著改善了持续性房颤患者心脏的内分泌功能。Objective:This study aimed to investigate the effect of left atrial appendage closure(LAAC)in combination with catheter radiofrequency ablation(CRFA)for atrial fibrillation(AF)on plasma brain natriuretic peptide(BNP)in patients with persistent AF.Methods:A total of 240 patients with persistent non-valvular AF were consecutively enrolled between April 2015 and October 2018.Of them,66 patients underwent LAAC using Watchman device combined with CRFA for AF(LAAC+CFRA group)and 174 received CRFA for AF only(CRFA group).Propensity score matching(PSM)was performed based on sex,age,CHA2DS2-VASc score and HAS-BLED score to reduce selection bias between the two groups.Venous blood samples were obtained for BNP assessment before and 1 day,2 days,3 days,3 months,and 1 year after the procedure.Results:65 matched pairs of patients were identified.Pulmonary vein isolation was successfully performed in both groups,and all patients were in sinus rhythm postoperatively.In the LAAC+CRFA group,the Watchman occluder was successfully implanted.In patients treated with CRFA plus LAAC,plasma BNP levels were decreased with the restoration of sinus rhythm,but rose at day 3 P>0.05 vs baseline BNP value).Plasma BNP levels were significantly decreased at 3 months post procedure compared with preoperative values[(102±128)ng/L vs(256±181)ng/L,P<0.001],and were furter reduced at 1-year follow-up[(66±53)ng/L vs(256±181)ng/L,P<0.001].The same trend was observed for plasma BNP levels in CRFA group.There was no significant difference in BNP levels between the two groups.Conclusion:The combined procedure of LAAC with CFRA significantly improved the endocrine function of the heart.

关 键 词：心房颤动 经皮左心耳封堵 射频消融 脑钠肽 

分 类 号：R541.75[医药卫生—心血管疾病]