心房颤动合并帕金森病患者导管消融治疗的初步研究

Preliminary study of catheter ablation in patients with atrial fibrillation combined with Parkinson’s disease

目的:初步探讨心房颤动合并帕金森病(PD)患者导管消融治疗可行性、潜在获益。方法:纳入北京安贞医院自2017年3月至2019年9月,接受导管消融的心房颤动合并PD患者8例。记录患者基线数据,术中消融情况、围术期并发症,随访患者术后心房颤动复发情况、症状改善、临床事件、抗心律失常与抗凝性药物停药情况。结果:患者中男性居多(7例,87.5%),平均年龄(68.3±9.0)岁,其中阵发性心房颤动/心房扑动(PAF/AFL)4例,持续性心房颤动(PeAF)4例,心房颤动平均病史为(5.2±4.7)年。8例患者共计完成9次导管消融治疗(其中1例2次消融),围术期均未发生卒中、心脏压塞、血管并发症和大出血事件。随访期间(9~39个月)患者总体窦律维持率为75%(PAF/AFL, 100%;PeAF, 50%)、症状较术前明显改善,1例(12.5%)死亡。术后6例(75%)暂停抗心律失常药物,7例(87.5%)暂停抗凝药物治疗。结论:心房颤动合并帕金森病患者行导管消融治疗安全、可行,术后多数患者症状改善明显,维持窦律(尤其PAF患者)。

Objective: To investigate the feasibility, potential benefits of catheter ablation in patients with atrial fibrillation(AF) combined wih Parkinson’s disease(PD). Methods: 8 patients with atrial fibrillation and PD were enrolled in Beijing Anzhen Hospital from March 2017 to September 2019. All patients were treated with catheter ablation. The type and parameters of ablation, perioperative complications, recurrence, symptom improvement, clinical events, anti-arrhythmia and anticoagulant drug withdrawal were observed. Results: 8 patients successfully performed 9 procedures(including 1 with 2 procedures). There were no stroke, cardiac tamponade, vascular complications and massive hemorrhage in the perioperative period. During the follow-up period(9-39 months), the overall sinus rhythm(SR) maintenance rate was 75%(PAF/AFL 100% SR, PeAF 50% SR), the symptoms were significantly improved, but one(12.5%) died. After procedures, 6 patients(75%) temporary terminated antiarrhythmic drugs, 7 patients(87.5%) temporary terminated oral anticoagulants. Conclusions: catheter ablation is safe and feasible in patients with atrial fibrillation combined with PD. Most of the patients have improved symptoms and maintained SR(especially patients with PAF) after the catheter ablation procedures.