CAJ | 학술논문

目的观察阵发性心房颤动(房颤)导管消融远期的成功率、抗凝或抗栓治疗和栓塞事件及抗心律失常药物治疗情况.方法回顾2000年1月至2004年12月连续住院的症状明显、药物治疗无效的阵发性房颤并行导管消融治疗的患者106例.所有患者均在环状标测电极(Lasso)引导下进行肺静脉节段性电隔离.术后通过24 h的Holter、体表心电图、话和书信进行长期随访,观察房颤复发、抗凝或抗栓治疗和栓塞事件、抗心律失常药物治疗及死亡等情况.结果成功随访97例,失访9例.随访病例中,男性65例,年龄(54.8±11.2)岁.平均随访(60.7±11.8)个月,3例因恶性肿瘤死亡.其余94例中,68例(72.3%)维持窦律(窦律组),26例(27.7%)房颤复发(复发组),其中8例(8.5%)为晚期复发.窦律组56例(82.4%)停用抗凝或抗栓治疗,没有发生栓寒事件.复发组中仅1例华法林抗凝,11例服用阿司匹林,其中2例发生脑栓塞;其余14例(53.8%)停用抗凝或抗栓治疗,1例发生脑栓塞.复发组栓塞发生率明显高于窦律组(P<0.01).窦律组停用抗心律失常药物治疗的比率明显高于复发组(80.9%比56.0%,P<0.05).结论阵发性房颤导管消融有较高远期成功率,远期复发率低;房颤根治者远期可以停用抗凝或抗栓治疗,且明显减少栓塞风险,并通过减少该类患者抗心律失常药物治疗,相应提高生活质量.
목적 관찰진발성심방전동(방전)도관소융원기적성공솔、항응혹항전치료화전새사건급항심률실상약물치료정황.방법 회고2000년1월지2004년12월련속주원적증상명현、약물치료무효적진발성방전병행도관소융치료적환자106례.소유환자균재배상표측전겁(Lasso)인도하진행폐정맥절단성전격리.술후통과24 h적Holter、체표심전도、화화서신진행장기수방,관찰방전복발、항응혹항전치료화전새사건、항심률실상약물치료급사망등정황.결과 성공수방97례,실방9례.수방병례중,남성65례,년령(54.8±11.2)세.평균수방(60.7±11.8)개월,3례인악성종류사망.기여94례중,68례(72.3%)유지두률(두률조),26례(27.7%)방전복발(복발조),기중8례(8.5%)위만기복발.두률조56례(82.4%)정용항응혹항전치료,몰유발생전한사건.복발조중부1례화법림항응,11례복용아사필림,기중2례발생뇌전새;기여14례(53.8%)정용항응혹항전치료,1례발생뇌전새.복발조전새발생솔명현고우두률조(P<0.01).두률조정용항심률실상약물치료적비솔명현고우복발조(80.9%비56.0%,P<0.05).결론 진발성방전도관소융유교고원기성공솔,원기복발솔저;방전근치자원기가이정용항응혹항전치료,차명현감소전새풍험,병통과감소해류환자항심률실상약물치료,상응제고생활질량.
Objective High short-term successful rate was reported for catheter ablation in patients with paroxysmal atrial fibrillation ( AF) , we analyzed the long-term outcome (success rate, anticoagulation therapy and embolism event, anti-arrhythmic therapy and death post procedure) of catheter ablation for paroxysmal AF in this study. Methods From January 2000 to December 2004, 106 consecutive patients with drug-refractory paroxysmal AF underwent catheter ablation and were followuped for (60. 7 ± 11.8) months. Segmental pulmonary vein isolation (SPVI) was routinely performed by radiofrequency energy under the guidance of circular mapping catheter. The patients were followed up with 24 h-holter, ECG, telephone or letter. Data on recurrence of AF, the anticoagulation medication and the incidence of embolism, anti-arrhythmic therapy were obtained. Results There were 9 patients lost to follow up. In the remaining 97 patients [65 males, (54. 8 ±11.2) years old] , 3 cases died from cancer, sinus rhythm was maintained in 68 patients (Group S, 72. 3% ) and AF recurrence evidenced in 26 patients (Group R, 27.7% ). In Group S, 56 patients (82. 4% ) discontinued anticoagulation medication, and 12 patients continued to take aspirin. There was no embolism event in Group S during follow-up. In Group R, 1 patient continued to take warfarin; 11 patients continued to take aspirin and 2 patients suffered from cerebral embolism. Anticoagulation medication was discontinued in 14 patients (53. 8% ) and 1 patient suffered form cerebral embolism. The incidence of embolism event in Group R is significantly higher than in Group S (P <0. 01). More patients discontinued anti-arrhythmic medication in Group S than in Group R ( 80. 9% vs. 56. 0% , P < 0. 05 ). Conclusion Catheter ablation is associated with satisfactory long-term success rate, reduced anti-arrhythmia medication, improved quality of life in patients with paroxysmal AF.