冷冻球囊消融治疗高龄阵发性心房颤动患者的安全性和有效性

Safety and effectiveness of cryoballoon ablation in elderly patients with paroxysmal atrial fibrillation

目的评价冷冻球囊消融在高龄阵发性心房颤动(AF)患者中应用的有效性和安全性。方法通过单中心的回顾性研究,分析我院2019年1月1日至2020年1月1日行冷冻球囊消融的高龄阵发性AF患者,统计其1年随访的AF复发率和严重并发症发生率,评价冷冻球囊消融在高龄阵发性AF患者中应用的有效性和安全性。结果本研究共60例患者,平均年龄(83.0±2.5)岁,男性36例(60%),CHA2DS2-VASc积分为3.0±1.0,42例(70%)合并高血压,18例(30%)合并糖尿病,18例(30%)合并冠心病,12例(20%)合并肾功能不全,平均手术时间(从开始静脉穿刺至撤除导管)为(70.0±10.5)min,左房内操作时间(从房间隔穿刺至撤除导管)为(40.0±6.0)min,平均冷冻消融次数为(5±1)次,冷冻消融时间为(14.0±2.0)min,X线曝光时间为(15.0±1.6)min。1个月随访时,4例患者出现持续时间>30 s的AF,后均自行转复;3个月随访时,2例患者出现心房扑动,静推伊布利特后心律转复;6个月随访时,全部患者均为窦性心律;12个月随访时,6例患者出现AF复发,加用胺碘酮后发作次数明显减少。在随访期内,60例患者均未发生神经系统功能障碍,未发生心房食管瘘等严重并发症。结论对于高龄阵发性AF患者,冷冻球囊消融能够安全、有效地完成肺静脉隔离。

Objective To evaluate the effectiveness and safety of cryoballoon ablation in elderly patients with paroxysmal atrial fibrillation(AF).Methods In this single-center retrospective study,geriatric patients with paroxysmal AF who underwent cryoballoon ablation in our hospital from January 1,2019 to January 1,2020 were enrolled.Further,the recurrence rate of AF and the incidence of serious complications at the 1-year follow-up were analyzed to evaluate the effectiveness and safety of cryoballoon ablation in these patients.Results A total of 60 patients were included in this study with an average age of(83.0±2.5)years,36(60%)patients were male.The average CHA2DS2-VASc score of was 3.0±1.0.The most common concomitant disease was hypertension(n=42,70%).Other disease included diabetes mellitus(n=18,30%),coronary heart disease(n=18,30%),renal insufficiency(n=12,20%).The average operation time(from the beginning of venipuncture to catheter removal)was 70±10.5 min,and the operation time in the left atrium(from the puncture of interatrial septum to catheter removal)was 40.0±6.0 min.The average number of cryoablation times per patient was 5±1,cryoablation time was 14.0±2.0 min,and radiography exposure time was 15.0±1.6 min.At the 1-month follow-up,four patients had paroxysmal atrial fibrillation with duration of>30 s,and all recovered spontaneously.At the 3-month follow-up,two patients developed atrial flutter and recovered after intravenous injection of ibutilide.At the 6-month follow-up,all patients had sinus rhythm.At the 12-month follow-up,six patients had atrial fibrillation recurrence,and the number of attacks was significantly reduced after amiodarone administration.During the follow-up period,none of the 60 patients had neurological dysfunction,atrial esophageal fistula or other serious complications.Conclusions For elderly patients with paroxysmal AF,cryoballoon ablation is a safe and effective method for pulmonary vein isolation.