射频消融治疗老年房扑房颤患者疗效及安全性的评价

The efficacy and safety of radiofrequency catheter ablation in treating atrial flutter or atrial fibrillation in the elderly

目的展望射频消融治疗老年房扑房颤患者的前景,评价其安全性及疗效。方法回顾3年来在北京大学第一医院进行射频消融的年龄在60-82岁的房扑房颤患者的病例。结果 46名患者中1例因不能耐受未能继续消融治疗;20例房扑患者全部消融成功,成功率100％,随访1-30个月无复发;25例房颤患者消融肺静脉78 条,以肺静脉电位消失为标准,成功率96％,随访1-30个月,5例复发,成功率80．0％。5例复发患者药物控制心室率;1例出现急性心脏压塞,治疗后好转。将该组并发症的发生率与同期在北京大学第一医院因阵发性室上性心动过速行射频消融的年龄16-60岁组并发症的发生率进行比较,差异无显著性。结论射频消融因其安全性、有效性,对老年患者可明显减少药物副作用,提高生活质量,可成为无禁忌房扑房颤患者的一线治疗方案。

Objective To look forward to the prospects of radiofrequency catheter ablation（RFCA） and evaluate the safety and efficacy of RFCA in treating atrial flutter（AF） or atrial fibrillation（ Af） in the elderly （ 〉 60-year old）. Methods A total of 46 patients aged from 60 to 82 with AF or M was treated with RFCA from 2002 to 2004. Results Of the 46 patients, one gave up the treatment because of intolerance. RFCA was successful in all of the 20 patients with AF. In the 1 - 30 months followed-up, no patient got AF again. In 25 M patients, 78 pulmonary veins were ablated to the criterion of disappearance of pulmonary venous potential, with a success rate of 96%. The 1 - 30 months follow-up showed that 5 patients got M again who then took drug to control ventricular rate and success was achieved in 80% of patients. One patient got acute pericardiac tamponade. There was no significant difference in the incidence of complication between this group and the group who received RFCA treatment for paroxysmal superventricular tachycardia at the age from 16 to 60 during the same period in our hospital. Conclusion RFCA may be the first-line therapy for AF or Af in the elderly without contraindications, because it is safe and effective, and can reduce drug sideeffect and improve quality of life.