CARTO系统引导下射频消融治疗老年心房颤动的术后复发相关因素分析

Radiofrequency ablation guided by CARTO system for treating atrial fibrillation in elderly patients: an analysis on factors related to postoperative recurrence

目的评价CARTO三维标测系统引导下以环肺静脉口消融术为核心并联合其他射频消融术式治疗老年心房颤动(房颤)患者的临床有效性和安全性,分析老年房颤患者术后复发的相关因素。方法入选2010年4月～2016年8月于解放军第252医院住院首次接受房颤射频消融术治疗的患者共102例,所有患者均接受以环肺静脉隔离术治疗为核心并联合其他射频消融术式的治疗方案,其中术后即刻成功为90例,手术失败未达到消融目的有12例。将术后即刻成功的90例患者分为老年人房颤组(≥60岁,49例)和非老年人房颤组(<60岁,41例),跟踪随访患者长期预后情况。并观察手术的成功率、复发率、并发症发生情况,分析老年房颤复发的相关因素。结果通过跟踪随访房颤射频消融术患者,发现老年组与非老年组在术后复发率上无显著性差异(28.57%vs. 24.39%,P>0.05),其复发因素与术前左房内径(LAD,mm)和病史时间(年)密切相关。老年组与非老年患者导管消融成功并维持窦性心律,其术后LAD与术前相比均减小(P<0.05),而两组患者经导管消融术后未能维持窦性心律的,其术后LAD与术前相比未见明显变化(P>0.05)。两组患者术前左心室射血分数(LVEF)值与术后比较未见明显变化(P>0.05)。患者术后发生心包少量积液、少量渗出性胸腔积液、穿刺部位血肿等并发症,均经积极处理后好转,但无心包填塞、脑卒中等严重并发症发生。结论 CARTO三维标测系统引导下的导管消融治疗老年房颤是安全有效的。术前LAD(mm)和病史时间(年)是老年患者导管消融术后房颤复发的危险因素。

Objective To review the effectiveness and safety of circumferential pulmonary-vein ablation(CPVA)combined with other radiofrequency ablation(RFA)guided by CARTO system for treating atrial fibrillation(AF)in elderly patients,and analyze factors related to postoperative AF recurrence.Methods The patients(n=102)firstly received RFA were chosen from Chinese PLA 252 Hospital from Apr.2010 to Aug.2016.All patients were given CPVA as core therapy combined with other RFA,and the procedure was immediately successful in 90 patients and was failed in 12 patients.The patients with immediate success(n=90)were divided into elderly AF group(aged≥60,n=49)and non-elderly AF group(aged<60,n=41).The success rate,recurrent rate and incidence of complications were observed,and factors related to AF reoccurrence were analyzed.Results The follow-up results showed that postoperative recurrent rate had no significant difference between 2 groups(28.57%vs.24.39%,P>0.05).The reoccurrence factors were closely related to left atrial diameter(LAD,mm)and medical history(y).LAD decreased in patients with successful RFA and sinus rhythm maintenance in 2 groups after the procedure(P<0.05),and LAD had no significant changes in patients without sinus rhythm maintenance in 2 groups after the procedure(P>0.05).LVEF had no significant changes in 2 groups after the procedure(P>0.05).The complications,including hydropericardium,exudative pleural effusion and hematoma of puncture site were observed in patients and improved after treatment.There were no other severe complications such as cardiac tamponade and stroke observed.Conclusion RFA guided by CARTO system is safe and effective in treatment of senile AF.Pre-operation LAD(mm)and medical history time(y)are risk factors of AF recurrence in elderly patients.