高龄老年心房颤动患者行导管射频消融的安全性和有效性研究

The clinical safety and efficacy of radiofrequency catheter ablation for atrial fibrillation in patients aged≥80 years

目的评价80岁及以上高龄老年心房颤动(简称房颤)患者行导管射频消融治疗的安全性和有效性。方法纳入2015年8月至2019年2月在上海交通大学附属第一人民医院首次行导管射频消融术的374例60岁及以上房颤患者,按年龄分为高龄组(≥80岁)96例和非高龄组(<80岁)278例。收集两组患者的基线临床资料及手术相关信息,术后随访至少6个月,比较两组患者围手术期并发症发生率、单次术后房颤复发率等差异。房颤复发定义为手术3个月后,经心电图或动态心电图证实的房颤、心房扑动和/或房性心动过速发作,且持续时间大于30 s。围手术期主要并发症包括:心包压塞、其他大出血事件、脑梗塞及其他栓塞事件、肺静脉狭窄、膈神经麻痹、心房食管瘘和死亡。结果与非高龄组相比,高龄组高血压病患病率(76.0%vs 64.7%)、糖尿病患病率(35.4%vs 23.0%)、CHA2DS2-VASc评分(4.1±1.2 vs 3.2±1.4)、HAS-BLED评分(2.2±0.8 vs 1.8±0.8)、血清肌酐水平[(82.2±24.5)umol/L vs(71.9±19.0)umol/L)]均更高(P均<0.05),而肌酐清除率[(57.0±16.0)ml/min vs(83.5±24.5)ml/min,P<0.001]更低,房颤病程[12.0(3.0~36.0)个月vs 24.0(4.0~48.0)个月,P=0.042]更短。高龄组患者的手术时间[(245.4±57.1)min vs(224.4±54.2)min,P=0.022]更长,而X线曝光时间、盐水灌注量等其他手术相关参数无显著差异(P>0.05)。高龄组和非高龄组两组患者全部并发症发生率(3.1%vs 3.6%)和主要并发症发生率(1.0%vs 1.4%)相似(P>0.05)。术后平均随访(21.1±11.8)个月,单次导管射频消融术后高龄组与非高龄组房颤复发率无差异(20.8%vs 17.8%,P=0.504)。结论经过谨慎选择的80岁及以上的高龄老年房颤患者行导管射频消融是安全和有效的,其并发症发生率和单次手术成功率与非高龄患者相当。

Objective To evaluate the clinical safety and efficacy of radiofrequency catheter ablation for atrial fibrillation(AF)in patients aged≥80 years.Methods A total of 374 patients aged≥60 years who performed AF radiofrequency catheter ablation in Shanghai General Hospital were enrolled,from August 2015 to February 2019.All patients were divided to group 1(≥80 years,n=96)and group 2(<80 years,n=278).The clinical baseline data,procedural parameters and periprocedure complications were recorded.All patients were followed up at least 6 months.The recurrence of AF was defined as episode of AF/atrial flutter/atrial tachycardia lasted more than 30 seconds,recorded by ECG or Holter after 3 months post-procedure.The major complications included pericardial tamponade,other severe hemorrhage events,stroke and other embolism events,pulmonary vein stenosis,phrenic nerve palsy,atrioesophageal fistul and death.Results The hypertension morbidity(76.0%vs 64.7%),diabetes morbidity(35.4%vs 23.0%),CHA2 DS2-VASc score[(4.1±1.2)vs(3.2±1.4)],HAS-BLED score[(2.2±0.8)vs(1.8±0.8)]and creatinine level[(82.2±24.5)umol/L vs(71.9±19.0)umol/L]were higher in group 1 than those in group 2(P<0.05).The creatinine clearance[(57.0±16.0)ml/min vs(83.5±24.5)ml/min,P<0.001]was lower and duration of AF history[12.0(3.0-36.0)month vs 24.0(4.0-48.0)month,P=0.042]was shorter in group 1 than that in group 2.The procedure time[(245.4±57.1)min vs(224.4±54.2)min,P=0.022]was longer in group 1,but there was no differences in other procedure parameters such as the X ray exposure time and volume of saline irrigation between 2 groups(P>0.05).The total complication rate(3.1%vs 3.6%)and major complication rate(1.0%vs 1.4%)were similar between group 1 and group 2(P>0.05).The recurrence rates of AF after a single procedure were 20.8%in group 1 and 17.8%in group 2(P=0.504)after a mean follow-up of(21.1±11.8)months.Conclusion The complication rate and single procedure success rate are similar in highly selected patients aged≥80 years and patients aged between 60 to 79 years.The procedure of radiofrequency catheter ablation for AF is safe and effective in highly selected patients aged≥80 years.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(6):549-554]