心房颤动射频消融术术后并发急性缺血性脑卒中临床研究

The clinical research of acute ischemic cerebral stroke in atrial fibrillation patients after cardiac radiofrequency ablation

目的：回顾性分析心房颤动（AF）患者行心脏射频消融术（CRA）后,住院期间并发急性缺血性脑卒中（AICS）的发生率、病死率、危险因素及住院天数;方法：检索北京安贞医院统计系统,2009年1月1日至2012年12月31日,出院诊断中包括＂阵发性或持续性AF＂,并实施CRA的住院病例;入选患者根据术后住院期间是否发生急性脑卒中分为病例组及对照组,比较术后脑卒中发病率、预后、危险因素及住院天数在两组间的差异,并进行多因素回归分析其独立危险因素;结果：共收集符合入选标准4 126例次,CRA后住院期间并发AICS发病率0.5%（21/4,126例）、其中脑梗死19例、短暂性脑缺血发作（TIA）2例,病死率0.95%（2/21例）;与对照组比较病例组住院时间延长[（25.19±19.9）vs.（7.32±4.27）d,P=0.000]、既往更多存在持续性AF（13/21 vs.1597/4 105,P=0.031）和既往更多脑卒中病史（9/21 vs.224/4105,P=0.000）;外科直视射频消融术（RFA）和内科射频导管消融（RFCA）比较,前者术后更多并发脑卒中（4/132 vs.17/3 994,P=0.004）;多因素回归分析既往脑卒中史（OR=12.811,95%CI：5.311-30.788）及持续性AF（OR=2.493,95%CI：1.025-6.062）是CRA术后住院期间并发脑卒中的独立危险因素;结论：AF行CRA术后住院期间并发脑卒中总体发病率较低,以脑梗死居多,有一定病死率,并延长了住院时间;术后并发卒中的独立危险因素为既往脑卒中病史及持续性AF,术前筛选和严格掌握适应症有助于减少术后并发脑卒中。

Objective： To study the morbidity, prognosis after cardiac radiofrequency catheter ablation, and analyze the risk factors of postoperative stroke. Methods ：The atrial fibrillation inpatient cases including persistent and paroxysmal ones that had cardiac radiofrequency ablation were collected in Beijing Anzhen hospi- tal from January 2009 to December 2012. The incidence of AICS complicated by selected cases of radiofrequen- cy ablation occurred during hospitalization was analyzed. Two groups were divided, including stroke group and control group. We compared the incidence, prognosis, risk factors and length of hospitalization between the two groups. We also studied the independent risk factors of AICS complicated after cardiac radiofrequency ablation. And then, multiple logistic regression analysis was performed. Results： A total of 4,126 cases were enrolled in this present study. The morbidity of stroke after cardiac radiofrequency catheter ablation was 0. 51% （21/4, 126）, including 19 cases of ischemic infarction （2 cases accompanied with hemorrhagic transformation）, 2 cases of TIA. The mortality was 0.95% （2 / 21 cases）. The in-hospital days [（25.19± 19.9） vs 7.32 ± 4. 27d,P =0. 000] , the forms of atrial fibrillation before operation （ 13/21 vs. 1597/4105 ,P = 0. 031 ）, and previous history of stroke （9/21 vs 224/4105, P = 0. 000） were more common in stroke group. Radio frequency ablation （RFA） was prone to complicate with stroke compared with Radio frequency catheter ablation （RFCA） （4/132 vs, 17/3,994, P =0. 004）. Muhiple logistic regression analysis was showed that the past history of stroke （ OR = 12. 811, 95% CI 5. 311-30. 788 ） and persistent atrial fibrillation （ OR = 2. 493, 95% CI 1,025-6. 062 ） were independent risk factors of stroke after cardiac radiofrequency catheter ablation. Conclusion： The morbidity of AICS in atrial fibrillation patients with cardiac radio frequency catheter ablation was low, however the prognosis was poor. The past history of stroke and persistent atrial fibrillation were independent risk factors of stroke.