消融指数与压力导管指导下射频消融术治疗老年阵发性心房颤动的疗效和术后复发率分析

Study on efficacy,recurrence rate and related risk factors between ablation index and contact force guided radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients

目的:比较消融指数(AI)和压力导管(CF)指导下射频消融治疗老年阵发性心房颤动(房颤)患者的疗效和预后情况。方法:选取2018年4月至2019年4月在北京友谊医院心内科住院并首次接受射频消融治疗的≥60岁阵发性房颤患者共77例,根据手术方式分为AI组(40例)和CF组(37例)。术后随访1年,比较2组患者的单圈环肺静脉电隔离术(PVI)成功率、安全性、复发率,并分析与消融术后复发的相关因素。结果:研究最终纳入77例患者,年龄(68.5±6.4)岁,男40(51.9%)例。AI组单圈PVI成功率[52.5%(21例)比29.7%(9例), P=0.011]高于CF组,消融时间[(24.5±1.7)min比(33.7±2.2)min, P<0.001]及总手术时间[(136.6±6.1)min比(139.7±7.4)min, P=0.048]均短于CF组。术后随访1年,生存分析显示AI组房颤累积复发率低于CF组(22.5%比40.5%, P=0.048)。多因素分析结果显示,CF指导射频消融( HR=3.272,95% CI:1.319-8.114, P=0.011)、左心房直径扩大( HR=4.233,95% CI:1.511-11.862, P=0.006)及合并冠心病( HR=4.829,95% CI:1.399-16.666, P=0.013)是老年患者射频消融术后复发的相关因素。 结论:与CF相比,AI指导的射频消融提高了PVI单圈成功率,缩短了手术时间,减少了术后复发率。CF指导射频消融、左心房前后径扩大及合并冠心病是老年患者射频消融术后复发的相关因素。

Objective To compare the efficacy,safety and recurrence rate between ablation index(AI)and contact force(CF)guided radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients.Methods Elderly patients(age≥60 years)with paroxysmal atrial fibrillation who received radiofrequency ablation for the first time at Department of Cardiology,Beijing Friendship Hospital from April 2018 to April 2019 were enrolled.Patients were divided into 2 groups:AI-group(n=40)and CF group(n=37)depending on their ablation methods.Follow-up was performed until 1 year post the procedure,and efficacy related indexes like first-pass pulmonary vein isolation(PVI)rate,ablation duration,operation duration and major complications were compared between 2 groups.The recurrence rates between 2 groups and related risk factors after radiofrequency ablation were analyzed.Results A total of 77 patients[mean age(68.5±6.4)years,40 were male]were enrolled at last.In AI guided patients,frequency of first-pass PVI rate was higher[52.5%(21 cases)vs 29.7%(3 cases),P=0.011]with a shorter ablation duration[(24.5±1.7)min vs(33.7±2.2)min,P<0.001]and operation duration[(136.6±6.1)min vs(139.7±7.4)min,P=0.048]compared with CF guided group.At 1 year follow-up,AI group showed an amendatory recurrence rate in Kaplan-Meier analysis(22.5%vs 40.5%,log-rank P=0.048).Multivariate Cox regression analysis showed that CF guided ablation(HR=3.272,95%CI:1.319-8.114,P=0.011),enlarged anteroposterior diameter of the left atrium(HR=4.233,95%CI:1.511-11.862,P=0.006)and complicated with coronary heart disease(HR=4.829,95%CI:1.399-16.666,P=0.013)were independent risk factors for recurrence of atrial fibrillation in elderly patients.Conclusions Compared with CF guided ablation,radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients guided by AI showed a higher first-pass PVI rate,shorter procedure duration of both ablation time and total operation time,meanwhile a lower recurrence rate.Further analysis revealed that different ablation alternation(AI or CF),enlarged anteroposterior diameter of left atrium,and complicated with coronary heart disease are independent risk factors for recurrence after radiofrequency ablation of atrial fibrillation in elderly patients.