持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

The relationships between anticoagulation therapy during operation and thromboembolic events in patients with persistent/permanent atrial fibrillation who underwent radiofrequency catheter ablation

目的探讨持续性心房颤动（房颤）患者经导管射频消融术中不同抗凝方案与围术期血栓事件的关系。方法2004年7月至2007年10月连续收治行导管射频消融治疗的持续性房颤145例。所有患者术前均口服华法林抗凝，使国际标准化比率（INR）控制在2．0—3．0至少1个月。消融前停用华法林并用低分子肝素替代抗凝。2004年7月至2006年1月消融的患者（组Ⅰ）64例，完成房间隔穿刺后，静脉给予普通肝素5000U；2006年2月至2007年10月消融的患者（组Ⅱ）81例，完成房间隔穿刺后根据患者体重予以肝素（100U／kg），两组患者消融术中每小时均追加肝素1000U。消融后行低分子肝素抗凝3d并口服华法林治疗至少3个月。结果组Ⅰ有4例患者于围术期出现血栓形成或血栓栓塞；组Ⅱ1例持续性房颤患者因消融后第3天自行停用华法林出现短暂性脑缺血发作，其余严格抗凝的患者均未出现血栓事件。组Ⅰ与组Ⅱ消融术前后达到抗凝要求的持续性房颤患者血栓事件发生率差异有统计学意义（4／64对0／80，P=0．037）。结论消融中根据患者体重调整抗凝强度可以显著减少持续性房颤患者围术期血栓事件并发症的发生。

Objective The relationships between different anticoagulation methods during radiofrequency catheter ablation （ RFCA ） of persistent/permanent atrial fibrillation （AF） and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Antieoagulation with warfarin was administrated in all patients before operation for at least 1 month, with the international normalized ratio（INR） maintained between 2. 0 and 3.0. Before procedure, warfarin was discontinued and replaced by low molecular weight heparin （ LMWH ）. After atrial septum puncture, a total of 5000 U unfractioned heparin （UFH）were given to patients of group Ⅰ who underwent the ablation from July 2004 to January 2006, while patients of group H who underwent the ablation from February 2006 to October 2007 were heparinized（ 100 U/Kg） according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ （64 patients ,51 men）experienced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ （ 81 patients ,67 men）who didn＇ t fulfill the anticoagulation therapy experienced TIA after ablation. No thromboembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ （4/64 vs. 0/80, P = 0. 037 ）. Conclusions Strengthen the anticoagulation therapy according to patients＇ weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.