心房颤动射频导管消融相关无症状脑梗死的临床特点及危险因素

Clinical characteristics and risk factors of silent cerebral infarction associated with atrial fibrillation catheter ablation

目的探讨心房颤动(房颤)射频导管消融相关无症状脑梗死(silent cerebral infarction,SCI)的临床特点及危险因素。方法本研究为单中心前瞻性临床观察性研究,连续入选2019年1月至2020年3月在徐州医科大学附属医院心内科首次行射频导管消融术的房颤患者94例。术后24~48 h行头颅弥散加权磁共振(DWMRI)检查,明确有无SCI,同时记录患者相关临床资料,监测术中活化凝血时间(ACT),对SCI发生的可能危险因素进行多因素逻辑回归分析。结果15例(15/94,15.96%)患者术后DWMRI显示17处新发SCI病灶,10处(10/17,58.82%)位于右侧半脑。SCI组术中平均ACT显著低于无SCI组[240(235,258)s对262(245,280)s,P=0.001]。多因素逻辑回归分析显示术中平均ACT水平是SCI发生的唯一独立危险因素(OR=0.965,95%CI 0.940~0.991,P=0.008)。结论房颤射频导管消融围术期SCI发生率较高,术中ACT水平是其独立危险因素。

Objective To investigate the clinical characteristics and possible risk factors of silent cerebral infarction(SCI)associated with atrial fibrillation(AF)radiofrequency catheter ablation(RFCA).Methods This study is a single-center prospective clinical observational study.A total of 94 patients with AF,undergoing RFCA for the first time from January 2019 to March 2020 in Affiliated Hospital of Xuzhou Medical University,were prospectively enrolled.Cerebral diffusion weighted magnetic resonance imaging(DWMRI)was performed 24-48 h after ablation to determine possible SCI.Clinical data and intraoperative active cloting time(ACT)levels were recorded to explore the risk factors of SCI by multivariate logistic regression analysis.Results Postoperative DWMRI depicted 17 new SCI lesions(SCI group)in 15 cases(15/94,15.96%),10(10/17,58.82%)located in the right hemisphere.The intraoperative mean ACT level in SCI group was significantly lower than that in no SCI group[240(235,258)s vs.262(245,280)s,P=0.001].Multivariate logistic regression analysis showed that mean ACT level was the only independent risk factor associated with the occurrence of SCI(OR=0.965,95%CI 0.940-0.991,P=0.008).Conclusion The incidence of SCI associated with AF ablation was high,and intraoperative ACT was the independent risk factor.