CAJ | 학술논문

目的：阵发性房颤终止后出现的症状性长间歇往往需要植入永久性心脏起搏器,本研究旨在评估导管消融对该类患者的疗效。方法连续入选2010年1月至2012年6月在北京安贞医院住院治疗的阵发性房颤合并房颤终止后症状性长间歇的患者作为研究对象,43例患者进行了导管消融(导管消融组),57例患者进行了永久性起搏器植入(起搏器组)。根据相关指南推荐,所有进行导管消融的43患者术前均为起搏器植入的Ⅰ类指征,随访消融前后评估起搏器指征,消融组随访观察导管消融的效果,此外,术前及随访(20.1±9.6)个月后再次进行起搏器指征评估,发现41例患者不再具备起搏器植入的指征(Ⅲ类指征)。结果随访结束时,两组之间总体心脏原因再住院率无差异(P=0.921)；起搏器植入组服用抗心律失常药物比例显著高于导管消融组(起搏器组40.4%,导管消融组4.7%,P<0.001),然而导管消融组窦性心律维持率显著高于起搏器治疗组(导管消融组83.7%,起搏器组21.1%,P<0.001)。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；大多数这类患者经导管消融手术成功根治房颤后避免了起搏器的植入。
목적：진발성방전종지후출현적증상성장간헐왕왕수요식입영구성심장기박기,본연구지재평고도관소융대해류환자적료효。방법련속입선2010년1월지2012년6월재북경안정의원주원치료적진발성방전합병방전종지후증상성장간헐적환자작위연구대상,43례환자진행료도관소융(도관소융조),57례환자진행료영구성기박기식입(기박기조)。근거상관지남추천,소유진행도관소융적43환자술전균위기박기식입적Ⅰ류지정,수방소융전후평고기박기지정,소융조수방관찰도관소융적효과,차외,술전급수방(20.1±9.6)개월후재차진행기박기지정평고,발현41례환자불재구비기박기식입적지정(Ⅲ류지정)。결과수방결속시,량조지간총체심장원인재주원솔무차이(P=0.921)；기박기식입조복용항심률실상약물비례현저고우도관소융조(기박기조40.4%,도관소융조4.7%,P<0.001),연이도관소융조두성심률유지솔현저고우기박기치료조(도관소융조83.7%,기박기조21.1%,P<0.001)。결론대우진발성방전상관쾌-만종합정적환자,도관소융적총체효과가능우우기박기식입；대다수저류환자경도관소융수술성공근치방전후피면료기박기적식입。
Objective Symptomatic prolonged sinus pauses on termination of atrial fibrillation ( AF) are an accepted indication for pacemaker implantation. We evaluated the outcome of AF ablation in patients with paroxysmal AF-re-lated tachycardia-bradycardia syndrome and compared the efficacy of catheter ablation with permanent pacing plus anti-arrhythmic drugs ( AADs) . Method Patients with prolonged symptomatic sinus pauses on termination AF were retrospectively analyzed. Forty-three consecutive patients who underwent catheter ablation ( ABL group) were com-pared to 57 patients who underwent permanent pacing plus AADs (PM group). All 43 patients in the ABL group fulfilled ClassⅠindication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-eval-uation after (20. 1±9. 6) months of follow-up showed that 41 patients did no longer need a pacemaker because of being AF-free with no recurrent symptoms of prolonged sinus pause ( Class Ⅲ indication) . Result Total cardiac-re-lated re-hospitalization was not significantly different between the two groups. More patients in the PM group were on AADs (PM 40. 4%, ABL 4. 7%,P<0. 001),while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up(83. 7%, vs 21. 1% in PM group,P<0. 001). Conclusion 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.