CHADS2评分对心房颤动导管消融并发症的预测价值

Complications prediction value of CHADS2 score in catheter ablation of atrial fibrillation

目的:探讨CHADS2评分对心房颤动(房颤)导管消融并发症的预测价值。方法:回顾性分析非瓣膜病房颤初次导管消融的患者共251例,计算入院时的CHADS2评分:心力衰竭(1分)、高血压(1分)、年龄≥75岁(1分)、糖尿病(1分)、既往脑卒中史(2分)。根据CHADS2评分,将患者分为CHADS2 0、1及≥2分3组,评价并发症发生率与CHADS2评分的关系。结果:251例房颤患者中,CHADS2=0的109例,CHADS2=1的75例,CHADS2≥2的67例。3组房颤病程、房颤类型、左房前后径、左室舒张末期内径、左室收缩末期内径、左室射血分数差异无统计学意义。发生并发症27例(10.7%)。并发症患者CHADS2评分显著高于无并发症患者[(1.4±1.3)∶(0.9±1.0),P<0.05]。CHADS2=0、1及≥2组并发症发生率分别为8.3%、8.0%及17.9%,差异无统计学意义;3组出血和血栓并发症发生率随着CHADS2评分的增加而显著增加,分别为2.8%、6.7%及14.9%(P<0.05)。在CHADS2的5个因素中,并发症的发生率在有和无糖尿病组[(32.1%∶8.1%,P<0.001)]以及有和无脑卒中病史组[(29.4%∶9.4%,P=0.010)]之间有统计学差异。结论:CHADS2≥2时,房颤导管消融血栓和出血并发症显著增加。

Objective：To explore if CHADS2 score could predict complications in catheter ablation of atrial fi- brillation （Af）. Method： All 251 patients undergoing catheter ablation of Af were enrolled. CHADS2 score was calculated as follows., two points were assigned for history of stroke or transient ischemic attack and 1 point each was assigned for age ≥75, history of hypertension, diabetes, recent cardiac failure. Result： Of the 251 patients, 109 patients had CHADS2 =0, 75 patients had CHADS2 = 1, 67 patients had CHADS2≥ 2. There were no differences of Af duration, Af typet, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-aystolic diameter and ejection fraiction among the three groups. There were 27 patients suffered complications （10.7%）. CHADS2 score was significantly higher in the patients with complications [（1.4± 1.3） vs （0. 9± 1.0）,P〈0.05] than those without. The incidence rate were 8.3%, 8.0%, 17.9% among the groups with C HADS2= 0,1,≥2, respectively （P = 0. 087）. The thrombotic and bleeding complications was significantly in- creased with CHADS2 score with the complication rate 2.8%, 6.7 %, 14.9 % among the three groups（P〈0. 05）. The complication rate was significantly higher in the patients with diabetes （32.1% VS. 8.1% ,P〈0. 001） and previous stroke （29.4% VS 9.4% % ,P=0. 010） than those without. Conclusion： CHADS2 score have an important role in the prediction of complication in catheter ablation of Af.