摘要
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.
作者
卢文杰
潘亮
王玺
陈晓杰
陈英伟
李然
韩战营
秦小飞
孙国举
邱春光
LU Wenjie;PAN Liang;WANG Xi;CHEN Xiaojie;CHEN Yingwei;LI Ran;HAN Zhanying;QIN Xiaofei;SUN Guoju;QIU Chunguang(Department of Cardiovascular Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,Henan,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第7期680-685,共6页
Chinese Circulation Journal
基金
河南省高等学校重点科研项目计划(18A320016)。
关键词
心房颤动
冷冻球囊消融
射频导管消融
新发
无症状脑梗死
atrial fibrillation
cryo-balloon ablation
radiofrequency ablation
new-onset
asymptomatic cerebral embolism