X线引导下左心耳封堵联合导管消融术的有效性和安全性分析  

The effectiveness and safety of X-ray guided left atrial appendage occlusion combined with catheter ablation

作　　者：罗阳 胥良[2,3] 王琰 赵育洁 LUO Yang;XU Liang;WANG Yan;ZHAO Yujie(Xinxiang Medical University,Xinxiang,He'nan,453003,China;Department of Cardiology,the 7th People's Hospital of Zhengzhou;He'nan Medical Key Laboratory of Arrhythmias)

机构地区：[1]新乡医学院,河南新乡453003 [2]郑州市第七人民医院心内科 [3]河南省心律失常医学重点实验室

出　　处：《临床心血管病杂志》2024年第5期388-393,共6页Journal of Clinical Cardiology

基　　金：河南省科技攻关项目(No:222102310667);2021郑州市名医支持项目(No:5);2022郑州市科技惠民项目(No:2022KJHM0033);河南省自然科学基金项目(No:212300410305)。

摘　　要：目的:评估X线引导下左心耳封堵联合导管消融术的有效性和安全性。方法:纳入2017年3月—2022年4月在郑州市第七人民医院住院并接受导管消融的非瓣膜性心房颤动(房颤)患者,通过倾向性评分匹配,分为经食管超声心动图联合X线组(TEE组,73例)和单用X线组(DSA组,73例)。随访12个月,比较两组围手术期与随访期资料,评估单用X线指导左心耳封堵联合导管消融术的有效性、安全性以及经济效益。结果:两组患者均成功完成导管消融和左心耳封堵。DSA组少量心包积液事件发生率(20.5%vs8.2%)、住院时间[(10.5±2.7)dvs(9.3±2.6)d]和住院花费[(156517.7±13271.2)元vs(146028.1±12481.1)元]均显著低于TEE组(均P<0.05)。两组随访期间终点事件发生率均差异无统计学意义。结论:对于左心耳封堵联合导管消融,X线单独引导的有效性和安全性并不劣于X线联合经食管超声心动图,且在减少住院花费和住院时间上具有一定的优势。Objective:To explore the effectiveness and safety of X-ray guided left atrial appendage occlusion combined with catheter ablation.Methods:Patients with non-valvular atrial fibrillation who underwent catheter ablation and were admitted to the 7th Peoples Hospital of Zhengzhou from March 2017 to April 2022 were included.These patients were divided into the transesophageal echocardiography combined with X-ray group(TEE group,n=73)and the X-ray group(DSA group,n=73)using propensity score matching.Followed up for 12 months,perioperative and follow-up data were compared between the two groups,the effectiveness,safety,and economic benefits of using X-ray guidance alone for left atrial appendage occlusion combined with catheter ablation were evaluated.Results:Patients in both groups successfully completed catheter ablation and left atrial appendage occlusion.The incidence of small pericardial effusion(20.5%vs 8.2%),hospitalization duration[(10.5±2.7)d vs(9.3±2.6)d],and expenses[Y(156517.7±13271.2)vs￥(146028.1±12481.1)]in theDSAgroup were significantly lower than those in the TEE group(all P<0.05).There was no statistically significant difference in the incidence of endpoint events during the followup period between the two groups.Conclusion:For left atrial appendage occlusion combined with catheter ablation,the effectiveness and safety of X-ray guidance alone are not inferior to that of X-ray combined with transesophageal echocardiography guidance,and it has certain advantages in reducing hospitalization costs and length of stay.

关 键 词：导管消融 左心耳封堵 数字减影血管造影术 倾向评分匹配 

分 类 号：R541.7[医药卫生—心血管疾病]