经食道超声心动图对心房颤动围手术期脑卒中临床价值的研究

Transesophageal echocardiography in evaluation of perioperative stroke in patients with atrial fibrillation undergoing catheter ablation

目的探讨经食道超声心动图(transesophageal echocardiography,TEE)检查对评估心房颤动患者行射频消融术(radiofrequency catheter ablation,RFCA)围手术期脑卒中的临床价值。方法对420例拟行RFCA的非瓣膜性心房颤动患者术前行TEE检查,围手术期予抗凝治疗。以RFCA术后1个月内出现脑卒中的8例患者为研究对象,412例未出现围手术期脑卒中的患者作为对照组进行研究。对临床资料及TEE检查资料进行总结分析。结果非瓣膜性心房颤动行RFCA患者,围手术期发生脑卒中多与既往冠心病史[odds ratio(OR)6.0,P=0.03]或脑卒中史(OR 8.2,P=0.02)相关。脑卒中组与非脑卒中组比较,TEE检查参数(包括自发性显影、左心耳面积、左心耳排空峰值速度、卵圆孔未闭、房间隔膨胀瘤)在两组间均无统计学差异,各变量与RFCA围手术期脑卒中无相关性。结论非瓣膜性心房颤动行RFCA围手术期应用抗凝药物的患者,TEE检查参数(除外左房血栓)并未提示与围手术期脑卒中的发生相关。尽管自发性显影、左心耳面积、左心耳排空峰值速度、卵圆孔未闭、房间隔膨胀瘤等是血栓形成的因素,但未增加心心房颤动动患者RFCA围手术期脑卒中的发生。

Objective To evaluate transesophageal echocardiography （TEE） in predicting perioperative cerebrovascular accident （CVA） in patients with atrial fibrillation （AF） undergoing radiofrequency catheter ablation （RFCA）. Methods Pre-operative TEE was performed in 420 patients with non-valvular AF who underwent RFCA and received anticoagulation perioperatively. Among them 8 patients developed perioperative CVA within 1 month after RFCA and 412 patients did not develop CVA （control group）. General status and TEE parameters were analyzed in two groups. Results The risk factors for perioperative CVA in patients undergoing RFCA were coronary artery disease with odds ratio （OR） of 6.0 （ P = 0.03 ], previous history of CVA with OR of 8.2 （ P =0.02）. There were no differences in TEE parameters （ SEC, LA appendage area, LA appendage peak emptying flow velocity, patent foramen ovale, atrial septal aneurysm ） between 2 groups. TEE parameters were independent with the occurrence of patients undergoing RFCA with perioperative CVA. Conclusion Transesophageal echocardiograph parameters may not predict occurrence of perioperative cardiovascular accidents in patients with non-valvular atrial fibrillation undergoing radiofrequency catheter ablation and receiving perioperative anficoagulation.