有脑出血病史的心房颤动患者导管消融的安全性及有效性

Safety and efficacy of catheter ablation for atrial fibrillation in patients with history of intracranial hemorrhage

目的:观察既往有脑出血病史的心房颤动患者进行抗凝和导管消融的安全性及有效性。方法:连续入选2008年1月至2016年1月,接受心房颤动导管消融且既往有脑出血病史的患者共40例(脑出血组)。每1例患者均匹配2个对照者(共80例患者)。结果:平均随访23.0(12.0,38.2)个月。脑出血组患者CHADS2积分[2.00(1.00,2.75)vs.1.00(0.00,2.00)分,P<0.05],CHA2DS2-VASc积分[2.00(2.00,4.00)vs.2.00(1.00,3.00)分,P<0.05],HAS-BLED积分[2.00(2.00,3.00)vs.1.00(0.00,2.00)分,P<0.001]均高于对照组。两组患者均成功接受射频消融。随访期间两组缺血性卒中差异无统计学意义(对照组有1例发生缺血性卒中);脑出血发生率亦差异无统计学意义(脑出血组有1例发生脑出血,对照组无脑出血发生,P=0.333)。在术后前3个月内心房颤动复发率差异无统计学意义(log-rank P=0.283),在术后3个月以后两组间的心房颤动复发率有明显差异(log-rank P=0.011)。单因素回归分析显示脑出血病史是心房颤动复发的唯一预测因素。结论:既往有脑出血病史的心房颤动患者,导管消融是安全的,并未增加出血风险。

Objective:To investigate the risks and benefits of radiofrequency catheter ablation(RFCA)in atrial fibrillation(AF)patients with a history of intracranial hemorrhage(ICH).Methods:Between January 2008 and January 2016,a total of 40 patients with AF and prior ICH were recruited.All patients underwent RFCA and were followed up for assessment of maintenance of sinus rhythm and clinical outcomes.The control group included 80 individuals who presented for AF ablation and did not have a history of ICH.Two controls were matched for each study group patient in terms of sex,age(±2 years),type of AF,and procedure date.Results:Patients in the ICH group had higher CHADS2[2.00(1.00,2.75)vs.1.00(0.00,2.00),P<0.05],CHA2DS2-VASc[2.00(2.00,4.00)vs.2.00(1.00,3.00),P<0.05],and HAS-BLED scores[2.00(2.00,3.00)vs.1.00(0.00,2.00),P<0.001].All participants in both groups underwent successful RFCA.After a mean follow-up of 23.0(12.0,38.2)months,1 patient in control group had ischemic stroke;and the incidences of ICH during follow-up(1 vs.0,P=0.333)were similar between the groups.AF-free survival between the two groups was not significant(log-rank P=0.283)within the first 3 months,but was significant(log-rank P=0.011)after the first 3 months of CA.History of ICH was the only independent predictor of AF recurrence according to univariate Cox regression analysis.Conclusions:In AF patients with ICH history,AF ablation with a standard anticoagulation strategy(intravenous heparin was administered to maintain an activated clotting time ( ACT) of 250 to 350 seconds after a successful single transseptal puncture) is safe and does notseem to be associated with an increased risk of hemorrhage.