70岁以上心房颤动患者导管射频消融治疗临床分析

Catheter ablation treatment in patients older than 70 years of age with atrial fibrillation

目的分析70岁以上心房颤动(房颤)患者导管射频消融治疗成功率及术后复发危险因素。方法选择导管射频消融的70岁以上房颤患者107例,收集患者临床和电生理资料,采用Cox比例风险回归模型分析房颤消融术后复发危险因素。结果 107例患者中,阵发性房颤89例,持续性房颤18例。平均随访(25.2±11.5)个月,单次消融成功率67.3%,其中阵发性房颤和持续性房颤成功率分别为74.2%和33.3%(P<0.01)。复发的7例患者接受再次消融,6例成功。总的成功率72.9%。结构性心脏病及消融后仍为房颤心律是房颤消融术后复发的独立危险因素,单纯环肺静脉消融术式可减少复发房性心律失常风险。严重并发症4例,2例心包填塞、1例血胸和1例死亡。结论老年阵发性房颤导管射频消融成功率高;复发患者多数不接受重复消融;结构性心脏病、消融后仍为房颤心律是术后复发的独立危险因素,而在阵发性房颤患者单纯环肺静脉消融可能减少复发的房性心律失常。

Objective To evaluate the feasibility and safety of catheter ablation in patients older than 70 years of age with atrial fibrillation（AF）,and to identify predictors for recurrent atrial arrhythmias. Methods The clinical outcome of 107 patients with a follow-up 〉6 months who underwent catheter ablation for paroxysmal and persistent AF（89 and 18 patients respectively） was analyzed. Catheter ablation strategies included： circumferential pulmonary vein ablation（CPVA） and complex ablation. Cox proportional hazard multivariate regression analysis was performed to identify the predictors for recurrent atrial arrhythmias after ablation. Results After mean followup for（25.2±11.5） months,72 patients（67.3%） were freed from AF after a single ablation procedure. For the patients with paroxysmal AF and persistent AF,the success rates were 74.2% and 33.3% respectively. For arrhythmia recurrences, 7 patients underwent repeated procedures and after which 6 patients remained free from AF. The total success rate was 72. 9%. Cox regression analysis indicated that the predictors for recurrence were structural heart disease and AF at the end of the procedure. CPVA decreased the risk of recurrent atrial arrhythmias. There were 4 serious complications including 2 pericardial tamponade, 1 hemothorax and 1 death. Conclusions Catheter ablation is an effective treatment for patients over 70 years of age with paroxysmal AF. Structural heart disease and AF at the end of procedure are predictors for recurrent atrial arrhythmias. CPVA may decrease the risk of recurrent atrial arrhythmias, especially in paroxysmal AF.