CAJ | 학술논문

目的：分析冷冻球囊消融（CBA）治疗心房颤动（房颤）患者的单中心长期随访效果，探讨影响其疗效的相关临床因素。方法回顾性分析2009年1月至2013年4月接受CBA治疗的房颤患者的住院病历资料、手术记录和门诊随访资料。术前经胸超声测量左心房内径（LAD）。术后3个月后出现的房颤、心房扑动（房扑）、房性心动过速（房速）发作判定为CBA治疗失败。结果199例房颤接受CBA治疗，术中并发膈神经麻痹3例（1.5％），术后发生心包积液1例（0.5％）、短暂性脑缺血发作1例（0.5％），均自行缓解。在平均（23±14）个月随访中152例患者完成随访，其中65例（42.8％）治疗成功，失败患者中75例（86.2％）为术后12个月内复发。失败患者年龄较大[（62±7）比（52±10），P=0.0379]、LAD较大[（47±7）mm比（43±6）mm，P＜0.0001]，持续性房颤患者治疗成功率（29.5%）明显低于阵发性房颤患者（48.1％）。Logistic回归分析显示年龄[OR=1.037（1.000，1.076），P=0.0488]和LAD[OR=0.896（0.842，0.953），P=0.005]能独立预测初次CBA治疗效果。结论 CBA治疗房颤安全有效，长期随访效果较好。房性心律失常复发主要发生在术后12个月内。年龄和LAD是预测术后复发的独立危险因素。
목적：분석냉동구낭소융（CBA）치료심방전동（방전）환자적단중심장기수방효과，탐토영향기료효적상관림상인소。방법회고성분석2009년1월지2013년4월접수CBA치료적방전환자적주원병력자료、수술기록화문진수방자료。술전경흉초성측량좌심방내경（LAD）。술후3개월후출현적방전、심방복동（방복）、방성심동과속（방속）발작판정위CBA치료실패。결과199례방전접수CBA치료，술중병발격신경마비3례（1.5％），술후발생심포적액1례（0.5％）、단잠성뇌결혈발작1례（0.5％），균자행완해。재평균（23±14）개월수방중152례환자완성수방，기중65례（42.8％）치료성공，실패환자중75례（86.2％）위술후12개월내복발。실패환자년령교대[（62±7）비（52±10），P=0.0379]、LAD교대[（47±7）mm비（43±6）mm，P＜0.0001]，지속성방전환자치료성공솔（29.5%）명현저우진발성방전환자（48.1％）。Logistic회귀분석현시년령[OR=1.037（1.000，1.076），P=0.0488]화LAD[OR=0.896（0.842，0.953），P=0.005]능독립예측초차CBA치료효과。결론 CBA치료방전안전유효，장기수방효과교호。방성심률실상복발주요발생재술후12개월내。년령화LAD시예측술후복발적독립위험인소。
Objective To analyse long-term follow-up outcome of cryoballoon ablation (CBA) for atrial ifbrillation (AF) in a single center and to investigate the clinical relative factors which affecting the effect. Methods The inpatient, operating and outpatient data of patients, who were treated by CBA for AF in our center from January 2009 to April 2013, were retrospectively analyzed. Left atrium diameter (LAD) was measured by transthoracic echocardiography. Failure-treatment of CBA was defined by episode of AF, atrial lfutter, atrial tachycardia lasted for 30 seconds after 3 months. Results A total of 199 patients were enrolled. The rates of phrenic nerve paralysis, pericardial effusion, transient ischemic attack were 1.5%(n=3), 0.5%(n=1), 0.5%(n=1),respectively. All complications were resolved spontaneously.152 patients had completed follow-up data after ifrst-time CBA during a long-term follow-up of mean 23±14 months, 65 patients (42.8%) treated success. 75 patients with failure-treated were (86.2%) experienced the atrial arrhythmia recurrence in ifrst 12 month. The characteristics of failure-treated patients included with older age[(62±7) years vs. (52±10) years, P=0.0379]and larger LAD[(48±6)mm vs. (43±6) mm, P<0.0001]. The Logistic analysis showed that LAD[OR=0.896(0.842,0.953), P=0.005]and age[OR=1.037 (1.000,1.076), P=0.0488]could individually predict the treat-failure after ifrst CBA, and only LAD[OR=0.876 (0.822,0.935), P < 0.0001]could individually predict the total CBA. Conclusions CBA procedure for AF is safe and effective, and the result of long-term follow-up is preferable. Most atrial arrhythmia are recurred during ifrst 12 month after CBA. LAD can individually predict the failure in treatment of CBA.