肺癌外科术后合并心房颤动患者的导管消融治疗

Outcome of radiofrequency catheter ablation of atrial fibrillation in patients after lung cancer surgery

目的分析肺癌外科术后合并心房颤动(房颤)患者的临床及电生理特征,并评价此类患者接受导管消融治疗的效果。方法共入选14例肺癌外科术后合并房颤行导管消融的患者(观察组),按照1∶2随机选取同期入院消融的无肺部手术史的房颤患者作为对照组。所有患者均行导管消融,并随访心律失常复发情况。结果观察组患者体质量指数小于对照组[(23.6±3.1)kg/m2比(26.3±2.8)kg/m2,P=0.006],而合并糖尿病患者多于对照组(35.7%比7.1%,P=0.019);心房扑动或房性心动过速等在观察组患者中更为常见(64.3%比17.9%,P=0.002),且房颤相关症状更为严重。观察组患者的导管消融总手术时间及X线透视时间均高于对照组,差异有统计学意义[(197.5±73.2)min比(169.5±65.3)min,P<0.01]和[(45.7±28.5)min比(32.0±26.8)min,P<0.05]。随访期间,观察组和对照组分别有9例(64.3%)和14例(50.0%)复发心律失常。观察组患者单次消融的窦性心律维持率略低于对照组(35.7%比50.0%,P=0.185),但差异无统计学意义。结论对于肺癌外科术后合并房颤的患者,尽管单次消融成功率略低,导管消融仍是一种安全有效的治疗手段。

Objective To compare the clinical outcomes of radiofrequency catheter ablation（RFCA） for atrial fibrillation（ AF） between patients after lung cancer surgery and control patients.Methods Fourteen AF patients with lung cancer and prior lobectomy were included. For controls,28 procedure era-matched patients who did not have lung cancer or surgey were selected. All patients underwent catheter ablation and were followed up to assess maintenance of sinus rhythm. Results Compare with the control group,AF patients after lung cancer surgery had a lower body mass index [（23. 6 ± 3. 1） kg / m^2 vs.（26. 3 ± 2. 8） kg/m^2,P = 0. 006]and a higher co-morbiditly of diabetes（35. 7% vs. 7. 1%,P = 0. 19）.Atrial flutter or atrial tachycardia was more common in patients with lung cancer than in the control group（64. 3% vs. 17. 9%,P = 0. 002）. The clinical symptoms associated with AF in patients with lung cancer were more severe than the controls. Procedure time [（197. 5 ± 73. 2） min vs.（169. 5 ± 65. 3） min,P〈0. 01] and X-ray exposure time [（45. 7 ± 28. 5） min vs.（32. 0 ± 26. 8） min,P〈0. 05]were significantly longer in patients with lung cancer. During follow-up,9 AF patients with lung cancer and 14 patients the control group experienced AF recurrence. The rate of single procedure success in patients after lung cancer surgery was lower（35. 7%,5 /14） than that in the control group（ 50. 0%,14 /28）,but this difference was not statistically significant（ P = 0. 185）. Conclusions Although the single procedure success rate is slightly lower,RFCA for AF in patients after lung cancer surgery is safty and efficient.