房颤患者一站式手术与导管射频消融术后长期口服抗凝药物的5年随访结果比较

Comparison of 5-year follow-up outcomes between“one-stop”procedure and long-term oral anticoagulants after radiofrequency catheter ablation in patients with atrial fibrillation

目的比较心房颤动(房颤)患者行导管射频消融(RFCA)联合左心耳封堵(LAAC)与RFCA术后长期口服抗凝药物(OAC)的5年随访结果。方法本研究为回顾性横断面研究,纳入2015年9月至2017年12月在宁波大学附属第一医院心律失常诊疗中心行一站式手术的房颤患者(RFCA+LAAC组),收集患者的基线资料,并运用倾向评分匹配的方法按1∶1的比例从RFCA术后长期服用OAC的房颤患者中筛选出在临床基线资料上匹配的患者(RFCA+OAC组)。比较两组患者术后随访期间的窦性心律维持率和不良事件发生率。结果RFCA+LAAC组和RFCA+OAC组各纳入110例房颤患者,RFCA+LAAC组年龄(67.4±8.8)岁,女性42例(38.2%),RFCA+OAC组年龄(67.3±7.9)岁,女性47例(42.7%)。术后随访(5.3±1.1)年,随访期间两组的窦性心律维持率差异无统计学意义(log-rank:χ^(2)=0.277,P=0.602),缺血性卒中事件发生率差异无统计学意义[2.7%(3/110)比4.5%(5/110),P=0.719]。与RFCA+LAAC组相比,RFCA+OAC组出血事件发生率[6.4%(7/110)比18.2%(20/110),P=0.008]和大出血事件发生率[1.8%(2/110)比8.2%(9/110),P=0.030]更高。结论行RFCA+LAAC和RFCA+OAC的房颤患者在窦性心律维持率和缺血性卒中事件发生率方面无明显差异,RFCA+LAAC患者的出血风险更低。

ObjectiveTo compare the 5-year follow-up outcomes of radiofrequency catheter ablation(RFCA)combined with left atrial appendage closure(LAAC)and long-term oral anticoagulant(OAC)after RFCA in patients with atrial fibrillation.MethodsThis retrospective cross-sectional study included patients with atrial fibrillation who underwent"one-stop"procedure in the First Affiliated Hospital of Ningbo University from September 2015 to December 2017(RFCA+LAAC group).Baseline data of patients were collected.Propensity score matching at the ratio of 1∶1 was used to select patients with atrial fibrillation who took long-term OAC after RFCA(RFCA+OAC group).The maintenance rate of sinus rhythm and the incidence of adverse events during follow-up were compared between the two groups.ResultsA total of 110 patients were enrolled in the RFCA+LAAC group and RFCA+OAC group,respectively.Age of patients was(67.4±8.8)years in RFCA+LAAC group,and there were 42(38.2%)female patients.Age of patients was(67.3±7.9)years in RFCA+OAC group,and there were 47(42.7%)female patients.The patients were followed up for mean of(5.3±1.1)years.There was no significant difference in the maintenance rate of sinus rhythm(log-rank:χ^(2)=0.277,P=0.602)and incidence of ischemic stroke events(2.7%(3/110)vs.4.5%(5/110),P=0.719)during follow-up between the two groups.The incidence of bleeding events(6.4%(7/110)vs.18.2%(20/110),P=0.008)and major bleeding events(1.8%(2/110)vs.8.2%(9/110),P=0.030)was significantly higher in the RFCA+OAC group than in the RFCA+LAAC group.ConclusionThere is no significant difference between RFCA+LAAC group and RFCA+OAC group in maintenance rate of sinus rhythm and incidence of ischemic stroke events.Patients in the RFCA+LAAC group have a lower risk of bleeding events compared to the RFCA+OAC group.