单纯射频消融术与左心耳封堵术一站式治疗对心房颤动患者的临床疗效及预后观察

Clinical efficacy and prognosis of single radiofrequency ablation and left atrial appendage closure one-stop treatment in patients with atrial fibrillation

目的对比分析左心耳封堵术一站式治疗与单纯射频消融术对心房颤动患者的临床疗效及预后。方法选取2018年1月至12月于郑州大学第一附属医院住院治疗的心房颤动患者100例,根据治疗方案分为对照组(50例)和观察组(50例)。对照组仅接受射频消融术,观察组同时接受射频消融术与左心耳封堵术一站式治疗。两组术后均规范化口服抗凝药物(华法林、达比加群酯胶囊或利伐沙班片)及胺碘酮。观察两组患者的围术期并发症以评价两种治疗方案的临床疗效及安全性;随访统计两组患者术后不良事件的发生情况及观察组患者左心耳封堵器情况,比较两组患者的临床预后并进一步评估左心耳封堵术一站式治疗的临床疗效及成功率。结果两组患者围术期并发症发生率比较,差异未见统计学意义(P>0.05)。随访期间,对照组患者出血、脑卒中/短暂性脑缺血发作(TIA)的发生率均高于观察组,差异有统计学意义(P<0.05);随访期间,对照组与观察组房颤复发率、系统性栓塞发生率比较差异均未见统计学意义(P均>0.05)。观察组术中发生封堵器残余漏8例,术后随访1年,其中3例完全消失,其余5例较术中明显减少,差异有统计学意义(P<0.05)。结论对于有症状、高卒中风险且不愿长期口服抗凝药物的非瓣膜性心房颤动患者,左心耳封堵术一站式治疗较单纯射频消融术可有效降低出血及脑卒中/TIA发生率,且安全性高,临床疗效和预后良好。

Objective To compare and analyze the clinical efficacy and prognosis of single radiofrequency ablation and left atrial appendage closure one-stop treatment in the treatment of patients with atrial fibrillation. Methods One hundred patients with atrial fibrillation hospitalized in the First Affiliated Hospital of Zhengzhou University from January to December of 2018 were enrolled and divided into control group (50 cases) and observation group (50 cases). Patients in control group only received single radiofrequency ablation, and patients in the observation group received radiofrequency ablation and left atrial appendage closure. All patients were treated with standardized oral anticoagulant drugs (warfarin, dabigatinide capsules or rivaroxaban tablets) and amiodarone after surgery. The perioperative complications of the two groups were observed to evaluate the clinical efficacy and safety of the two treatment methods. The adverse events of the two groups 1 month, 3 months, 6 months and 12 months after surgery and left atrial appendage closure device of observation group were recorded in order to compare the clinical prognosis of the two groups and further evaluate clinical efficacy and success rate of left atrial appendage closure one-stop treatment. Results There was no statistically significant difference in the incidence of perioperative complications between the two groups (P>0.05). During the follow-up period, the incidence of bleeding and stroke/transient ischemic attack (TIA) in control group was higher than that in the observation group, and the difference was statistically significant (P<0.05). There was no significant difference in the recurrence rate of atrial fibrillation and the incidence of systemic embolism between the control group and the observation group (P>0.05). Residual leakage of the closure device occurred in 8 patients in the observation group. After 1 year of follow-up, residual leakage disappeared in 3 patients and significantly decreased in the remaining 5 patients, and the difference was statistically significant (P<0.05). Conclusions Compared with single radiofrequency ablation, left atrial appendageclosure one-stop treatment can effectively reduce the incidence of bleeding and stroke/TIA, with high safety, good clinical efficacy and prognosis in nonvalvular atrial fibrillation patients who have symptoms and high risk of stroke, however, do not want to take oral anticoagulants for a long time.