导管消融术治疗房性快速性心律失常对快慢综合征远期预后的观察

Long-term effect of catheter ablation on tachycardia-bradycardia syndrome

目的导管消融已成为快慢综合征的重要选择,但其远期疗效尚不清楚。方法回顾性分析2002年9月至2013年9月于大连医科大学附属第一医院住院治疗的150例快慢综合征患者。79例患者接受导管消融治疗(消融组)和71例患者接受起搏器植入治疗(起搏组)。结果消融组随访时间为(120.67±31.05)个月,起搏组随访时间为(123.01±29.68)个月。消融组患者接受(1.2±0.5)次导管消融治疗,56例(70.9%)患者维持窦性心律,均无长间歇和心动过缓发生而无需植入起搏器治疗。相反,起搏组患者均有心房颤动(简称房颤)发作。起搏组持续性房颤进展率明显高于消融组(9.9%vs 1.3%%,P<0.05)。起搏组新发脑卒中发生率显著高于消融组(15.4%vs 5.1%,P<0.05)。结论导管消融术可有效地治疗快慢综合征患者的房性快速性心律失常,从而避免继发性的缓慢性心律失常的发生。导管消融治疗可通过消除房颤和降低持续性房颤进展率而降低卒中发生率。

Objective Catheter ablation has been used for the treatment of tachycardia-bradycardia syndrome(TBS). However, data on its long-term effect of rhythm control and stroke are limited. Method Patients with TBS admitted in the First Affiliated Hospital of Dalian Medical University from 2002-2013 were reviewed in the present study. A total of 150 patients were enrolled. Seventy-nine patients underwent catheter ablation(CA group) and 71 patients chose implantation of pacemaker(PM group). Results Two groups were followed up(120.67±31.05) and(123.01±29.68) months, respectively(P>0.05). The CA group underwent 1.2±0.5 procedure. Of these, 70.9% patients exhibited sinus rhythm without long pauses or the need of anti-arrhythmia drugs. By contrast, no patient in PM group was free of atrial fibrillation(AF). A higher proportion in PM group progressed to persistent AF than in CA group(9.9% vs 1.3%, P<0.05). The incidence of new-onset stroke in PM group was significantly higher than that in CA group(15.4% vs 5.1%, P<0.05), despite higher rates of anticoagulation prescription. Conclusions Catheter ablation is effective for preventing both the tachycardia and bradycardia components for the majority of patients with TBS without the need for further pacemaker implantation. Moreover, ablation can reduce the stroke incidence of TBS.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(4):350-354]