CAJ | 학술논문

目的对比阵发性心房颤动(房颤)导管消融术后复发患者再次导管消融与微创外科消融的有效性和安全性.方法从首都医科大学附属北京安贞医院房颤中心随访数据库中筛选2007年8月至2012年8月首次导管消融复发后选择微创外科消融的阵发性房颤患者16例(外科消融组).根据年龄、性别、房颤病史和左心房内径,按1:2匹配后纳入32例首次导管消融复发后选择再次导管消融的患者(导管消融组).导管消融组以肺静脉电隔离为手术终点,必要时行线性消融.外科消融组则在肺静脉隔离后行心房迷走神经节消融、Marshall韧带消融和左心耳切除.结果两组患者一般临床特征差异无统计学意义.平均随访(30.6±18.9)个月,导管消融组和外科消融组中分别有22例(68.8％)和10例(62.5％)患者维持窦性心律(P=0.642),但外科消融组的手术相关并发症发生率显著高于导管消融组(31.3％对3.1％,P=0.021).结论阵发性房颤导管消融术后复发患者再次导管消融与微创外科消融手术效果相似,但安全性较高.
목적 대비진발성심방전동(방전)도관소융술후복발환자재차도관소융여미창외과소융적유효성화안전성.방법 종수도의과대학부속북경안정의원방전중심수방수거고중사선2007년8월지2012년8월수차도관소융복발후선택미창외과소융적진발성방전환자16례(외과소융조).근거년령、성별、방전병사화좌심방내경,안1:2필배후납입32례수차도관소융복발후선택재차도관소융적환자(도관소융조).도관소융조이폐정맥전격리위수술종점,필요시행선성소융.외과소융조칙재폐정맥격리후행심방미주신경절소융、Marshall인대소융화좌심이절제.결과 량조환자일반림상특정차이무통계학의의.평균수방(30.6±18.9)개월,도관소융조화외과소융조중분별유22례(68.8％)화10례(62.5％)환자유지두성심률(P=0.642),단외과소융조적수술상관병발증발생솔현저고우도관소융조(31.3％대3.1％,P=0.021).결론 진발성방전도관소융술후복발환자재차도관소융여미창외과소융수술효과상사,단안전성교고.
Objective The purpose of this study was to compare the efficacy and safety of a repeat catheter ablation (CA)or minimally surgical ablation(SA) for patients with failed prior CA for paroxysmal atrial fibrillation(AF).Methods Sixteen paroxysmal AF patients(SA group) who failed prior CA underwent minimally SA between August 2007 and August 2012.They were matched to 32 paroxysmal AF patients(CA group)who had failed prior CA and underwent repeated CA.SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary veins,ganglia ablation and left atrial appendage excision with optional additional lines.Repeated CA consisted of circumferential antral pulmonary vein isolation and optional additional linear ablation.The primary end point was arrhythmia-free survival without antiarrhythmic medication.Results After a mean follow-up of (30.6± 18.9) months(range 6～66 months),freedom from AF and antiarrhythmic drugs (AADs)was 62.5％(10/16)in SA group and 68.8％ (22/32) in CA group (P =0.642),but periprocedural complication rates were significantly higher in SA group than in CA group (31.3％ vs.3.1％,P =0.021).Conclusion For patients with paroxysmal AF who have failed prior CA,a repeat CA is as effective as minimally SA,meantime has less complication.