阵发性心房颤动导管消融的远期随访研究

Chronic outcome of patients with paroxysmal atrial fibrillation post catheter ablation

目的观察阵发性心房颤动（房颤）导管消融远期的成功率、抗凝或抗栓治疗和栓塞事件及抗心律失常药物治疗情况：方法回顾2000年1月至2004年12月连续住院的症状明显、药物治疗无效的阵发性房颤并行导管消融治疗的患者106例。所有患者均在环状标测电极（Lasso）引导下进行肺静脉节段性电隔离。术后通过24h的Holter、体表心电图、话和书信进行长期随访，观察房颤复发、抗凝或抗栓治疗和栓塞事件、抗心律失常药物治疗及死亡等情况。结果成功随访97例，失访9例。随访病例中，男性65例，年龄（54．8±11．2）岁。平均随访（60．7±11．8）个月，3例因恶性肿瘤死亡：其余94例中，68例（72．3％）维持窦律（窦律组），26例（27．7％）房颤复发（复发组），其中8例（8．5％）为晚期复发。安律组56例（82．4％）停用抗凝或抗栓治疗，没有发生栓塞事件。复发组中仅1例华法林抗凝，11例服用阿司匹林，其中2例发生脑栓塞；其余14例（53．8％）停用抗凝或抗栓治疗，1例发生脑栓塞。复发组栓塞发生率明显高于窦律组（P〈0．01）。窦律组停用抗心律失常药物治疗的比率明显高于复发组（80．9％比56．0％，P〈0．05）。结论阵发性房颤导管消融有较高远期成功率，远期复发率低；房颤根治者远期可以停用抗凝或抗栓治疗，且明显减少栓塞风险，并通过减少该类患者抗心律失常药物治疗，相应提高生活质量。

Objective High short-term successful rate was reported for catheter ablation in patients with paroxysmal atrial fibrillation （ AF）, we analyzed the long-term outcome （success rate, anticoagulation therapy and embolism event, anti-arrhythmic therapy and death post procedure） of catheter ablation for paroxysmal AF in this study. Methods From January. 2000 to December 2004, 106 consecutive patients with drug-refractory paroxysmal AF underwent catheter ablation and were followuped for （ 60. 7 ±11.8 ） months. Segmental pulmonary vein isolation （SPVI） was routinely performed by radiofrequency energy under the guidance of circular mapping catheter. The patients were followed up with 24 h-holter, ECG, telephone or letter. Data on recurrence of AF, the anticoagulation medication and the incidence of embolism, anti- arrhythmic therapy were obtained. Results There were 9 patients lost to follow up. In the remaining 97 patients [65 males, （54. 8 -＋ 11.2） years old], 3 cases died from cancer, sinus rhythm was maintained in 68 patients （ Group S, 72.3% ） and AF recurrence evidenced in 26 patients （ Group R, 27. 7% ）. In Group S, 56 patients （82.4%） discontinued anticoagulation medication, and 12 patients continued to take aspirin. There was no embolism event in Group S during follow-up. In Group R, 1 patient continued to take warfarin; 11 patients continued to take aspirin and 2 patients suffered from cerebral embolism. Anticoagulation medication was discontinued in 14 patients （53.8%） and 1 patient suffered form cerebral embolism. The incidence of embolism event in Group R is significantly higher than in Group S （P 〈 0. 01 ）. More patients discontinued anti-arrhythmie medication in Group S than in Group R （ 80. 9% vs. 56. 0% , P 〈 0. 05 ）. Conclusion Catheter ablation is associated with satisfactory long-term success rate, reduced antiarrhythmia medication, improved quality of life in patients with paroxysmal AF.