CAJ | 학술논문

目的探讨心房颤动(房颤)患者导管射频消融术后发生心包积液的处理并分析其相关危险因素.方法 156例房颤患者[男108例,女48例,阵发性房颤114例,平均年龄(57.6±11.3)岁]在三维标测系统及环状标测电极导管指导下行射频消融治疗[包括环肺静脉电隔离、线性消融及(或)碎裂电位消融],记录消融过程、部位、时间等因素,对术后证实出现心包积液的患者根据不同情况(心脏压塞或单纯心包积液)进行不同处理,并门诊随访心脏超声等.对可能影响术后出现单纯心包积液的因素进行分析.结果所有156例患者均完成肺静脉电隔离,共有16例(10.3%)出现心包积液,其中1例(0.6%)术后即刻出现心脏压塞,予心包穿刺后开胸探查抢救好转,随访18个月无特殊;另15例(9.6%)术后出现少量心包积液但无心脏压塞表现(单纯心包积液组),经保守治疗后好转,其中6例患者的心包积液在术后3个月消失,而另外9例则在术后6个月消失.单因素分析发现,单纯心包积液组与无心包积液组在性别组成(P<0.01)、有无行冠状静脉窦消融(P=0.026)、有无行碎裂电位消融(P=0.037)、有无行上腔静脉消融(P=0.041)等方面差异有统计学意义.Logistic多因素回归分析发现,女性[B=3.594,exp(b)=36.4,95%CI:4.2-312.1,P=0.001]、行冠状静脉窦消融[B=2.419,exp(b)=11.2,95%CI:1.0～124.6,P=0.049]是术后出现单纯心包积液的独立危险因素.结论房颤射频消融术后心包积液的发生率较高,但绝大部分并不出现心脏压塞,可经保守治疗得到改善,而不需要进一步有创治疗.女性及行冠状静脉窦消融是术后出现单纯心包积液的独立危险因素,房颤射频消融时应谨慎对待该部位的消融,以减少术后心包积液的发生.
목적 탐토심방전동(방전)환자도관사빈소융술후발생심포적액적처리병분석기상관위험인소.방법 156례방전환자[남108례,녀48례,진발성방전114례,평균년령(57.6±11.3)세]재삼유표측계통급배상표측전겁도관지도하행사빈소융치료[포괄배폐정맥전격리、선성소융급(혹)쇄렬전위소융],기록소융과정、부위、시간등인소,대술후증실출현심포적액적환자근거불동정황(심장압새혹단순심포적액)진행불동처리,병문진수방심장초성등.대가능영향술후출현단순심포적액적인소진행분석.결과 소유156례환자균완성폐정맥전격리,공유16례(10.3%)출현심포적액,기중1례(0.6%)술후즉각출현심장압새,여심포천자후개흉탐사창구호전,수방18개월무특수;령15례(9.6%)술후출현소량심포적액단무심장압새표현(단순심포적액조),경보수치료후호전,기중6례환자적심포적액재술후3개월소실,이령외9례칙재술후6개월소실.단인소분석발현,단순심포적액조여무심포적액조재성별조성(P<0.01)、유무행관상정맥두소융(P=0.026)、유무행쇄렬전위소융(P=0.037)、유무행상강정맥소융(P=0.041)등방면차이유통계학의의.Logistic다인소회귀분석발현,녀성[B=3.594,exp(b)=36.4,95%CI:4.2-312.1,P=0.001]、행관상정맥두소융[B=2.419,exp(b)=11.2,95%CI:1.0～124.6,P=0.049]시술후출현단순심포적액적독립위험인소.결론 방전사빈소융술후심포적액적발생솔교고,단절대부분병불출현심장압새,가경보수치료득도개선,이불수요진일보유창치료.녀성급행관상정맥두소융시술후출현단순심포적액적독립위험인소,방전사빈소융시응근신대대해부위적소융,이감소술후심포적액적발생.
Objective Pericardial effusion (PE) is a major complieation of atrial fibriuation ablation(AFB).We analyzed the incidence,risk factors and managements of PE post AFB(radiofrequency catheter ablation).Methods A total of 156 consecutive patients with AF [ male 108,paroxysmal AF 114, (57.6±11.3)years],who underwent AFB guided by a three-dimensional mapping system (CARTO or CARTO-Merge,Biosense-Webster Inc.Diamond Bar,California) and a circular mapping catheter(Lasso, Biosense-Webster Inc.Diamond Bar.California),were included in this study.The ablation strategy included Circumferential pulmonary veins isolation (CPVI).linear ablation and/or complex fraetionated atrial electrograms (CFAEs) ablation.Electrophysiologieal data and vital signs of patients were recorded by a multiple physiological recorder (Prueka,GE Medical System) during ablation.Ablation process,sites,duration and other related factors wen als0 recorded. Eehocardiography and other examinations were performed for diagnosing and monitoring PE.Results CPVl were achieved in all 156 patients.Incidenee of PE Was 10.3%(16/156)post AFB.One patient developed acute cardiac tamponade and emergency drainage of the perieardial effusion was performed through a median stemotomy and patient recovered without eomplieations during the 18 months f0U0w-up.The rest 15 PE patients with small PE received outpatient care and no invaBive treatment wag needed and PE disappeared after 3 months in 6 patients and after 6 months in 9 patients.Univariate analysis showed that the composition of gender(P<0.01).ablation in coronary sinus (CS,P=0=026),ablation of CFAEs(P=0.037) and superior vena cava(SVC,P=0.041)were risk factors for PE.Logistic regression analysis showed that hmMe gender [β=3.594,exp(b)=36.4,95% confidence interval(Cl):4.2-312.1,P=0.001] and ablation in CS [β=2.419,exp(b)=11.2, 95%cl:1.0-124.6,P=0.049] were independent risk factors for PE post AFB.Conclusions PE iS a common complication of AFB,female gender and ablation in CS were independent risk factors for PE.Most PE patients experienced spontaneous recovery but emergency treatment Wag needed for patient with cardiac tamponade.