75岁以上心房颤动患者射频导管消融及冷冻球囊消融疗效及安全性比较

Clinical safety and efficacy of radiofrequency catheter ablation and cryoballoon ablation in patients with atrial fibrillation aged over 75 years

目的比较75岁以上心房颤动(房颤)患者射频导管消融(RFCA)及冷冻球囊消融(CBA)的疗效及安全性。方法连续选取2016年8月至2020年12月于北部战区总医院心内科应用三维标测系统行环肺静脉电隔离及二代冷冻球囊消融隔离肺静脉的年龄>75岁的房颤患者,根据手术方式分为RFCA组(33例)及CBA组(70例)。术后随访至少6个月,比较两组患者的基线资料、手术即刻成功率、围术期并发症发生率及单次术后房颤复发率。结果共纳入103例房颤患者,年龄(77.26±2.28)岁,其中男38例。RFCA组(33例)中持续性房颤患者病程长于CBA组[70例,(45.00±31.07)个月对(18.92±25.19)个月,P=0.027]。RFCA组合并其他心律失常比例高于CBA组[39.4%(13/33)对5.7%(4/70),P<0.001]。其余基线资料两组之间差异无统计学意义(P>0.05)。RFCA组及CBA组两组的手术成功率差异无统计学意义[81.8%(27/33)对78.6%(55/70),P>0.05]。CBA组患者出现迷走神经反射比例高于RFCA组[24.3%(17/70)对3.0%(1/33),P=0.008]。CBA组发生膈神经损伤2例,RFCA组无膈神经损伤。两组患者心包积液、脑梗死及假性动脉瘤等发生率差异无统计学意义(P>0.05)。结论75岁以上房颤患者,选择RFCA及CBA均可获得较好的疗效及安全性,CBA中需加强迷走神经反射及膈神经损伤的监测。

Objective To evaluate the efficacy and safety of radiofrequency catheter ablation(RFCA)and cryoballoon ablation(CBA)in patients with atrial fibrillation aged over 75 years.Methods A total of 103 patients with atrial fibrillation aged>75 years who received RFCA by Carto system and CBA in the Department of Cardiology of General Hospital of Northern Theater Command from August 2016 to December 2020,including 38 males and 65 females,with a median age of(77.26±2.28)years.The patients were divided into the RFCA group(33 patients)and the CBA group(70 patients)according to the surgical method.The patients were followed up for at least 6 months after surgery.The differences in baseline data,immediate success rate of surgery,perioperative complication rate and recurrence rate of atrial fibrillation after a single operation were compared between the two groups.Results The duration of the patients with persistent atrial fibrillation in the RFCA group was longer than that in the CBA group[(45.00±31.07)month vs.(18.92±25.19)month,P=0.027].The incidence of other arrhythmias in the RFCA group was higher than that in the CBA group[39.4%(13/33)vs.5.7%(4/70),P<0.001].There were no statistically significant differences in the other parts of baseline information(all P>0.05).The proportion of vagal response in the CBA group was higher than that in the RFCA group[24.3%(17/70)vs.3.0%(1/33),P=0.008].There were 2 cases of phrenic nerve injury in the CBA group,and no phrenic nerve injury in the RFCA group.The incidence of the pericardial effusion,cerebral infarction and pseudoaneurysm between two group was no statistical difference(P>0.05).There was no statistical difference in the success rate of surgery between the RFCA group and the CBA group[81.8%(27/33)vs.78.6%(55/70),P>0.05].Conclusion For patients with atrial fibrillation over 75 years old,RF and second generation CBA can achieve better efficacy and safety.The monitoring of vagal response and phrenic nerve injury should be strengthened during CBA.