环肺静脉隔离附加选择性神经节丛消融对老年阵发性心房颤动患者的远期疗效  

Long-term effect of circumferential pulmonary vein isolation plus selective ganglionated plexus ablation in elderly patients with paroxysmal atrial fibrillation

作　　者：李宗师 白瑾[1] 孙丽杰[1] 刘书旺[1] Li Zongshi;Bai Jin;Sun Lijie;Liu Shuwang(Department of Cardiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院心内科,北京100191

出　　处：《中华心律失常学杂志》2025年第1期20-25,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨对老年(≥65岁)心房颤动(房颤)患者行环肺静脉隔离(CPVI)附加选择性右前神经节丛(RAGP)及左上神经节丛(LSGP)消融的有效性、安全性及长期预后。方法本研究为回顾性队列研究,分析2017年1月至2021年11月于北京大学第三医院心内科进行首次射频消融治疗的100例老年阵发性房颤患者的临床资料,根据治疗方式的不同分为CPVI组和CPVI附加RAGP及LSGP消融组(CPVI+GP组),每组50例。分析两组的手术时间和并发症情况;以术后复发房性心律失常为终点,应用Kaplan-Meier曲线分析及多因素Cox回归分析比较两组术后复发情况及影响因素。结果入组100例患者,男57例、女43例,年龄(71.26±5.55)岁,年龄范围65~86岁。术后随访36个月,两组患者的年龄、性别、合并症、心房大小等差异均无统计学意义(P>0.05);术后两组均无严重并发症发生。CPVI+GP组和CPVI组患者的无房性心律失常复发生存率分别为86%(43/50)和68%(34/50),差异有统计学意义(χ^(2)=4.432,P=0.034)。Cox回归分析中神经节丛消融与否是术后复发房性心律失常的独立危险因素(HR=0.354,95%CI 0.144~0.873,P=0.024),与年龄等其他危险因素无关;CPVI亚组中,年龄是阵发性房颤术后复发的独立危险因素(HR=1.210,95%CI 1.052~1.391,P=0.007);将年龄×手术分组作为交互项行Cox回归分析,年龄和手术方式存在相乘交互作用(HR=0.708,95%CI 0.538~0.932,P=0.014)。结论CPVI附加选择性RAGP及LSGP消融治疗相比单独CPVI降低了老年房颤患者术后房性心律失常的复发率,且不增加并发症风险。附加RAGP及LSGP消融的术式抵消了年龄增大对房颤复发的风险。ObjectiveTo investigate the effect of circumferential pulmonary vein isolation(CPVI)combined with selective right anterior ganglionated plexus(RAGP)and left superior ganglionated plexus(LSGP)in elderly patients(≥65 years)with atrial fibrillation(AF).MethodsAs a retrospective cohort study,a total of 100 elderly patients with paroxysmal AF who underwent radiofrequency catheter ablation(RFCA)for the first time in the Department of Cardiology in Peking University Third Hospital from January 2017 to November 2021 were analyzed.According to the different treatment,the patients were divided into CPVI group and CPVI combined with RAGP and LSGP ablation group(CPVI+GP group)with 50 cases in each group.The operation time and complications were recorded.Kaplan-Meier curve analysis and Cox regression analysis were used to compare postoperative recurrent atrial arrhythmias and their influencing factors.ResultsA total of 100 patients[57 males,43 females,mean age(71.26±5.55)years]were followed up for 36 months.There were no significant differences in age,gender,past history,atrial size,and other baseline charac-ConclusionCPVI combined with selective RAGP and LSGP ablation can reduce the recurrence rate of atrial arrhythmia in elderly patients with AF without increasing the risk of complications.Additional RAGP and LSGP ablation can offset the risk of recurrence of AF with age and benefit the elderly patients.

关 键 词：心房颤动 老年 神经节 自主 射频消融术 复发 

分 类 号：R541.7[医药卫生—心血管疾病]