心房颤动导管消融并发症变迁

Catheter ablation for the treatment of atrial fibrillation:transition of complications throughout learning curve

目的分析本中心不同阶段心房颤动(房颤)导管消融并发症的发生率和演变特征。方法2004年10月至2008年12月共有2260例房颤患者在本中心接受导管消融,包括男性1265例,女性995例;阵发性房颤1449例,慢性房颤811例。消融术式为三维标测系统指引环肺静脉电隔离术,对于慢性房颤附加碎裂电位消融。分为三个时间段(2004—2006年、2007年、2008年)统计并发症发生和诊治情况。结果共发生并发症61例(占2.70%),其中心脏压塞11例,血栓栓塞18例,肺静脉狭窄14例,血管穿刺并发症18例。2004—2006年心脏压塞5例(2例外科修补),脑栓塞3例(1例肌力减退),肠系膜动脉栓塞1例,肺静脉狭窄6例,血管穿刺并发症6例;2007年心脏压塞4例(2例外科修补),脑栓塞3例(1例死亡、2例肌力减退),肠系膜动脉栓塞1例,肺静脉狭窄4例,血管穿刺并发症5例;2008年心脏压塞2例(内科保守),脑栓塞7例(5例肌力减退),肠系膜动脉栓塞3例,肺静脉狭窄4例,血管穿刺并发症7例(1例血胸、1例股动静脉瘘,外科修补)。三个阶段并发症发生率差异无统计学意义(2.6%比2.6%比2.8%,P=0.93),2008年心脏压塞发生率(0.2%)较2004—2006年阶段(0.6%)和2007年阶段(0.6%)下降,P=0.5;血栓栓塞并发症发生率(1.0%)高于2004—2006年阶段(0.5%)和2007年阶段(0.6%),P=0.2。肺静脉狭窄和血管穿刺并发症发生率亦无显著变化。结论房颤导管消融总体安全性较好,虽然经验增加,但主要并发症并没有减少。

Objective To analyze the prevalence of complications following catheter ablation for atrial fibrillation and to describe the characteristics of transition of complications. Methods From October 2004 to December 2008, 2 260 cases （1 265 males） with atrial fibrillation （AF） were admitted for catheter ablation. AF was paroxysmal in 1 449 cases and chronic in 811 cases. Circumferential pulmonary vein isolation （CPVI） was carried out alone for paroxysmal AF and in combination with fractionated electrograms ablation for chronic AF. Complications were summarized and analyzed by dividing the whole duration into three sections ： Year 2004 - 2006, Year 2007 and Year 2008. Results Complications occurred in 61 cases （2.70%）. Cardiac tamponade developed in 11 cases, embolism in 18 cases, pulmonary vein stenosis in 14 cases, and vessel access related complications in 18 cases. In Year 2004 -2006, cardiac tamponade occurred in 5 cases, cerebral embolism in 3 cases, mesenteric artery embolism in 1 case, pulmonary vein stenosis in 6 cases, and vessel access related complications in 6 cases. In Year 2007, cardiac tamponade occurredin 4 cases, cerebral embolism in 3 cases, Mesenteric artery embolism in 1 case, pulmonary vein stenosis in 4 cases, and vessel access related complications in 5 cases. In Year 2008, cardiac tamponade occurred in 2 cases, cerebral embolism in 7 cases, mesenteric artery embolism in 3 cases, pulmonary vein stenosis in 4 cases, and vessel access related complications in 7 cases. There was no significant difference in the prevalence of complications among three sections. The prevalence of cardiac tamponade was lower in Year 2008 compared with that in the other two sections, P = 0. 5. However, the prevalence of embolism was higher in Year 2008 compared with that in the other two the sections, P = 0. 2. Conclusion It is safe to perform catheter ablation for the treatment of AF. Despite the improvement of technical skills, the prevalence of severe complications such as cardial tamponade, pulmonary vein stenosis or stroke did not decrease.