射频导管消融治疗风湿性心脏病患者心房颤动的疗效与安全性分析  

Analysis of the efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in patients with rheumatic heart disease

作　　者：金河 丰明俊[1] 杜先锋 郁一波[1] 傅国华 储慧民[1] JIN He;FENG Mingjun;DU Xianfeng;YU Yibo;FU Guohua;CHU Huimin(Arrhythmia Center,the First Affiliated Hospital of Ningbo University,Ningbo 315000,China)

机构地区：[1]宁波大学附属第一医院心律失常诊疗中心,315000

出　　处：《心电与循环》2024年第6期584-588,共5页Journal of Electrocardiology and Circulation

基　　金：浙江省医药卫生科技计划项目(2020KY821、2022KY302)。

摘　　要：目的分析射频导管消融(下称消融)治疗风湿性心脏病合并心房颤动(下称房颤)患者的疗效与安全性。方法回顾性选择2016年1月至2022年11月在宁波大学附属第一医院接受消融治疗的风湿性心脏病合并房颤患者47例,根据术后3个月后是否出现复发,分为复发组和未复发组,比较两组患者的临床特征,导管消融手术时程。结果单次消融手术时间为(128.6±31.4)min,X线暴露时间为7.2(4.1,12.0)min。术后出现中-大量心包积液、假性动脉瘤各1例。随访29(6,48)个月,单次消融总随访未复发率55.6%,再次消融总随访未复发率62.2%。复发组患者病程时间、手术时间长于未复发组[54个月、(139.4±23.2)min比24个月、(120.3±35.0)min],持续性房颤比例、瓣膜置换术后比例高于未复发组(85.0%、35.0%比48.0%、8.0%),差异均有统计学意义(均P<0.05)。Kaplan-Meier曲线分析显示,阵发性房颤患者初次消融后累积未复发房性心律失常率高于持续性房颤患者(P<0.05)。结论风湿性心脏病房颤二次消融的总有效率超60%,手术风险较低。Objective To analyze the efficacy and safety of radiofrequency catheter ablation(RFCA)for atrial fibrillation(AF)in patients with rheumatic heart disease(RHD).Methods The data of 47 patients with RHD and AF who underwent RFCA in the First Affiliated Hospital of Ningbo University from January 2016 to November 2022 were analyzed retrospectively.The patients were divided into relapse group and non-relapse group based on whether AF reoccurred during 3-months follow up.The clinical features of patients and catheter ablation procedure time were compared between the two groups.Results The procedure time and X-ray exposure time of initial ablation was(128.6±31.4)mins and 7.2(4.1,12.0)mins,respectively.There were 1 case of moderate to large pericardial effusion and 1 case of pseudo-aneurysm after the procedure.There was no AF relapsed in 55.6%patients after initial ablation and in 62.2%patients after repeat ablation during 29(6,48)months follow up.The course of the disease and the procedure time were 54 months and(139.4±23.2)min in relapse group,respectively,significantly higher than 24 months and(120.3±35.0)min in non-relapse group(all P<0.05).The proportions of persistent AF(85.0%vs.48.0%)and valve replacement(35.0%vs.8.0%)were significantly higher in relapse group than in non-relapse group(all P<0.05).Kaplan-Meier curve analysis showed that the cumulative time without AF after initial ablation was significantly higher in patients with paroxysmal AF than in patients with persistent AF(P<0.05).Conclusion The total efficacy after repeat ablation is over 60%for AF patients with RHD.The procedure risk is lower.

关 键 词：风湿性心脏病 瓣膜疾病 心房颤动 射频导管消融 

分 类 号：R541.75[医药卫生—心血管疾病] R541.2[医药卫生—内科学]