中国介入心脏病学杂志
中國介入心髒病學雜誌
중국개입심장병학잡지
CHINESE JOURNAL OF INTERVENTIONAL CARDIOLOGY
2014年
8期
477-482
,共6页
心房颤动%导管消融%起搏器%窦房结功能不全
心房顫動%導管消融%起搏器%竇房結功能不全
심방전동%도관소융%기박기%두방결공능불전
Atrial fibrillation%Catheter ablation%Pacemaker%Sinus node dysfunction
目的：评估导管消融对阵发性心房颤动（房颤）相关快-慢综合征的疗效。方法连续入选2010年1月至2012年9月在北京安贞医院房颤中心接受导管消融的50例阵发性房颤合并房颤终止后症状性长间歇的患者作为导管消融组，随访观察导管消融的效果。将同期在北京安贞医院因阵发性房颤相关症状性长间歇植入起搏器的61例患者作为起搏器组。比较随访结束时两组患者的窦性心律维持率、心血管原因再住院率等指标。结果导管消融组50例患者术前均具备起搏器植入的适应证，随访（22.3±10.5）个月后发现其中47例（94.0%）患者不再具备起搏器植入的适应证。随访结束时，起搏器组服用抗心律失常药物的比例多于导管消融组（P＜0.001），而窦性心律维持率低于导管消融组（起搏器组为21.3%，导管消融组为82.0%，P＜0.001）；两组心血管原因再住院率比较，差异无统计学意义（导管消融组22.0%，起搏器组24.6%，P=0.954），而起搏器组因快速心律失常发作再住院率高于导管消融组（起搏器组为14.8%，导管消融组为2.0%， P=0.02）；两组血栓事件发生率、心力衰竭发生率、死亡率等终点比较，差异均无统计学意义（均为P＞0.05）。结论对于阵发性房颤相关快-慢综合征的患者，导管消融的总体效果可能优于起搏器植入，这类患者大多数经导管消融手术成功根治房颤后，可以不用再植入起搏器。
目的：評估導管消融對陣髮性心房顫動（房顫）相關快-慢綜閤徵的療效。方法連續入選2010年1月至2012年9月在北京安貞醫院房顫中心接受導管消融的50例陣髮性房顫閤併房顫終止後癥狀性長間歇的患者作為導管消融組，隨訪觀察導管消融的效果。將同期在北京安貞醫院因陣髮性房顫相關癥狀性長間歇植入起搏器的61例患者作為起搏器組。比較隨訪結束時兩組患者的竇性心律維持率、心血管原因再住院率等指標。結果導管消融組50例患者術前均具備起搏器植入的適應證，隨訪（22.3±10.5）箇月後髮現其中47例（94.0%）患者不再具備起搏器植入的適應證。隨訪結束時，起搏器組服用抗心律失常藥物的比例多于導管消融組（P＜0.001），而竇性心律維持率低于導管消融組（起搏器組為21.3%，導管消融組為82.0%，P＜0.001）；兩組心血管原因再住院率比較，差異無統計學意義（導管消融組22.0%，起搏器組24.6%，P=0.954），而起搏器組因快速心律失常髮作再住院率高于導管消融組（起搏器組為14.8%，導管消融組為2.0%， P=0.02）；兩組血栓事件髮生率、心力衰竭髮生率、死亡率等終點比較，差異均無統計學意義（均為P＞0.05）。結論對于陣髮性房顫相關快-慢綜閤徵的患者，導管消融的總體效果可能優于起搏器植入，這類患者大多數經導管消融手術成功根治房顫後，可以不用再植入起搏器。
목적：평고도관소융대진발성심방전동（방전）상관쾌-만종합정적료효。방법련속입선2010년1월지2012년9월재북경안정의원방전중심접수도관소융적50례진발성방전합병방전종지후증상성장간헐적환자작위도관소융조，수방관찰도관소융적효과。장동기재북경안정의원인진발성방전상관증상성장간헐식입기박기적61례환자작위기박기조。비교수방결속시량조환자적두성심률유지솔、심혈관원인재주원솔등지표。결과도관소융조50례환자술전균구비기박기식입적괄응증，수방（22.3±10.5）개월후발현기중47례（94.0%）환자불재구비기박기식입적괄응증。수방결속시，기박기조복용항심률실상약물적비례다우도관소융조（P＜0.001），이두성심률유지솔저우도관소융조（기박기조위21.3%，도관소융조위82.0%，P＜0.001）；량조심혈관원인재주원솔비교，차이무통계학의의（도관소융조22.0%，기박기조24.6%，P=0.954），이기박기조인쾌속심률실상발작재주원솔고우도관소융조（기박기조위14.8%，도관소융조위2.0%， P=0.02）；량조혈전사건발생솔、심력쇠갈발생솔、사망솔등종점비교，차이균무통계학의의（균위P＞0.05）。결론대우진발성방전상관쾌-만종합정적환자，도관소융적총체효과가능우우기박기식입，저류환자대다수경도관소융수술성공근치방전후，가이불용재식입기박기。
Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation (AF) related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated (ABL group). In another 61 patients, paroxysmal AF was treated with anti-arrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control (PM group). Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation at the end of follow-up showed that 47 (94%) patients no longer needed a pacemaker (Class III indication) because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs (PM 42.6%, ABL 6.0%, P < 0.001) while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group (82.0%vs. 21.3%in PM group, P < 0.001). The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group (PM group 14.8%, ABL group 2.0%, P=0.020).The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.
