环肺静脉消融治疗老年患者心房颤动的有效性和安全性分析

Efficacy and Safety of Circumferential Pulmonary Vein Ablation of Atrial Fibrillation in Elderly Patients

目的:分析环肺静脉消融治疗老年患者心房颤动的有效性和安全性,并分析其术后复发危险因素。方法:通过多中心临床注册研究的方式分析全国2006年1-12月460例行环肺静脉消融治疗老年房颤患者(年龄≥60岁)的有效病例资料,观察手术的成功率、复发率和并发症发生情况,并分析其复发危险因素。结果:在平均(9.0±3.7)月的随访期间,环肺静脉消融治疗老年患者心房颤动的成功率为75.9%,复发率为24.1%。阵发性房颤、持续性房颤和永久性房颤成功率分别为77.1%、69.4%和55.6%。消融总的并发症发生率为3.0%,其中心包压塞7例(1.5%),皮下血肿5例(1.1%),感染1例(0.2%),脑卒中1例(0.2%)。术前左房内径增大是消融后房颤复发的危险因素(P<0.01)。结论:环肺静脉消融治疗老年患者心房颤动具有较好的有效性和安全性,术前左房内径增大是消融后房颤复发的危险因素。

Objective：To investigate the safety and efficacy of circumferential pulmonary vein ablation （CPVA） in elderly patients with atrial fibrillation （AF）, and to search for the possible predictors of AF recurrence after ablation. Methods： Data from 460 elderly patients （age≥60 years） who were underwent CPVA for AF from January 2006 to December 2006 in multiple hospitals were collected; success rate, recurrence rate and complications were analyzed. The relationship between the recurrent AF and clinical and echocardiographic variables was investigated. Results： After a mean follow-up of （9.0±3.7） months, the success rate and recurrence rate was 75.9% and 24.1%, respectively. The success rate of paroxysmal AF, persistent AF and permanent AF was 77.1%, 69.4%, and 55.6%, respectively. Complications occurred in 14 patients （3.0%）, including pericardial tamponade in 7 cases （1.5%）, ecchymoma in 5 cases （1.1%）, infection in 1 case （0.2%） and stroke in 1 case （0.2%）. Left atrium dimension （LAD） enlargement was the risk factor of recurrent AF （P0.01）. Conclusion： PVA is a safe and effective treatment for AF, and LAD enlargement is a risk factor of recurrent AF after ablation.