心房颤动冷冻球囊或射频导管消融术后新发无症状脑梗死的发生情况及预后

Prevalence and Outcome of New-onset Asymptomatic Cerebral Embolism After Cryo-balloon or Radiofrequency Catheter Ablation in Patients With Atrial Fibrillation

目的:比较心房颤动(房颤)患者冷冻球囊消融(CBA)与射频导管消融(RFCA)术后新发无症状脑梗死(NACI)的发生情况和预后。方法:连续入选2017年7月至2019年6月符合纳入和排除标准的267例房颤患者,随机分为CBA组(n=133)与RFCA组(n=134)。术前和术后24 h内行头颅3.0T MRI检查,记录基线、术中和术后资料。采用二元Logistic回归分析评估房颤消融术后发生NACI的危险因素。进行1年临床随访,记录房颤复发及脑血管事件发生情况。结果:CBA组和RFCA组患者的临床基线资料相似,消融术后NACI(15.04%vs.12.69%)和1年房颤复发率(24.19%vs.25.95%)差异也均无统计学意义(P均>0.05)。二元Logistic回归分析显示,既往脑卒中史(OR=3.113,95%CI:1.444~6.714)、术中电转复(OR=3.148,95%CI:1.399~7.138)和手术时间(OR=1.027,95%CI:1.005~1.050)均是消融术后发生NACI的危险因素(P均<0.05)。随访1年时,术后出现NACI的患者中缺血性脑卒中的发生率明显高于未出现NACI的患者(10.81%vs.1.83%;OR=6.485,95%CI:1.546~27.195,P=0.011),死亡(2.70%vs.0.46%)和血管性认知障碍(5.41%vs.1.38%)发生率有升高趋势,但差异均无统计学意义(P均>0.05)。结论:房颤患者CBA和RFCA术后NACI的发生率相似,术后出现NACI的患者预后不良。

Objectives:To explore the prevalence and prognosis of new-onset asymptomatic cerebral infarction(NACI)after cryoballoon ablation(CBA)or radiofrequency catheter ablation(RFCA)in patients with atrial fibrillation(AF).Methods:A total of 267 consecutive AF patients,who underwent CBA or RFCA from July 2017 to June 2019,were enrolled and patients were randomly divided into CBA group(n=133)and RFCA group(n=134).Head 3.0T MRI was performed before and within 24 hours after operation.Baseline,intra-and post-operative parameters were recorded and compared.Patients were clinically followed up for 1 year,recurrence of AF and cerebrovascular events were recorded.Results:The baseline clinical characteristics of the two groups were similar(all P>0.05).NACI rate after ablation(15.04%in CBA group vs.12.69%in RFCA group,P=0.578)and 1-year recurrence rate of AF(24.19%vs.25.95%,P=0.746)were similar between the two groups.Binary logistic analysis showed that history of previous stroke(OR=3.113,95%CI:1.444-6.714),cardioversion(OR=3.148,95%CI:1.399-7.138)and operation time(OR=1.027,95%CI:1.005-1.050)were risk factors of NACI(all P<0.05).Incidence rate of ischemic stroke at 1 year follow up was significantly higher in patients with NACI than in patients without NACI(10.81%vs.1.83%;OR=6.485,95%CI:1.546-27.195,P=0.011),while the incidence rates of death(2.70%vs.0.46%)and vascular cognitive impairment(5.41%vs.1.38%)tended to be higher in NACI group as compared to non-NACI group(both P>0.05).Conclusions:There is no difference in the incidence of NACI post CBA or RFCA in AF patients.NACI is related to increased risk of stroke at 1 year post ablation in AF patients.