冷冻球囊消融术与射频导管消融术治疗阵发性心房颤动的疗效比较及术后1年复发的危险因素探讨

Comparison of Therapeutic Effect between Cryoballoon Ablation and Radiofrequency Catheter Ablation in the Treatment of Paroxysmal Atrial Fibrillation and Discussion on the Risk Factors of Recurrence 1 Year after Operation

目的:对比冷冻球囊消融术(CBA)与射频导管消融术(RFCA)治疗阵发性心房颤动(AF)的疗效,并探讨术后1年复发的危险因素。方法:选择2019年2月~2021年2月期间我院收治的阵发性AF患者100例,根据手术方案的不同将患者分为A组(n=48,RFCA)和B组(n=52,CBA)。对比两组手术相关指标、并发症发生率和术后1年复发率情况。根据是否复发将所有患者分为复发组和无复发组,多因素Logistic回归分析术后1年复发的危险因素。结果:B组的手术时间、消融时间、X线曝光时间短于A组(P<0.05)。B组的并发症总发生率低于对照组(P<0.05)。两组复发率组间对比差异无统计学意义(P>0.05)。单因素分析显示,阵发性AF患者术后1年复发与B型利钠肽(BNP)、年龄、白细胞计数(WBC)、体质量指数、肌酐(Cr)、合并高血压、超敏C反应蛋白(hs-CRP)、合并糖尿病、左心房内径(LAD)、合并冠心病、病程、尿酸、心电图f波类型有关(P<0.05)。多因素分析结果显示:病程偏长、尿酸偏高、LAD偏大、年龄偏大、hs-CRP偏高、心电图f波类型为细波、BNP偏高是阵发性AF患者术后1年复发的危险因素(P<0.05)。结论:CBA与RFCA治疗阵发性AF,均可获得较好的疗效,CBA在改善患者手术情况及安全性方面的效果较好。阵发性AF患者术后1年的复发率较高,病程、尿酸、LAD、年龄、hs-CRP、BNP、心电图f波类型均是其影响因素。

Objective:To compare the efficacy of cryoballoon ablation(CBA)and radiofrequency catheter ablation(RFCA)in the treatment of paroxysmal atrial fibrillation(AF),and to explore the risk factors of recurrence 1 year after operation.Methods:100 patients with paroxysmal AF who were admitted to our hospital from February 2019 to February 2021 were selected,and the patients were divided into group A(n=48,RFCA)and group B(n=52,CBA)according to the different operation schemes.The operation related indicators,the incidence of complications and the recurrence rate of 1 year after operation were compared in the two groups.All patients were divided into recurrence group and non-recurrence group according to whether or not they had a recurrence.Multivariate Logistic regression were used to analyze the risk factors of recurrence 1 year after operation.Results:The operation time,ablation time and X-ray exposure time in the group B were shorter than those in the group A(P<0.05).The total incidence of complications in the group B was lower than that in the control group(P<0.05).There was no significant difference in recurrence rate between the two groups(P>0.05).Univariate analysis showed that the recurrence of paroxysmal AF patients 1 year after operation was related to B-type natriuretic peptide(BNP),age,white blood cell count(WBC),body mass index,creatinine(Cr),combined hypertension,high-sensitivity C-reactive protein(hs-CRP),diabetes,left atrial diameter(LAD),combined coronary heart disease,course of disease,uric acid,and the type of f wave in electrocardiogram(P<0.05).Multivariate analysis showed that longer course of disease,higher uric acid,larger LAD,older age,higher hs-CRP,fine wave type of f wave in electrocardiogram,and higher BNP were risk factors for recurrence of paroxysmal AF patients 1 year after operation(P<0.05).Conclusion:Both CBA and RFCA have a good effect in the treatment of paroxysmal AF.CBA has a good effect in improving the operation condition and safety of patients.The recurrence rate of patients with paroxysmal AF was high one year after operation,and the course of disease,uric acid,LAD,age,hs-CRP,BNP,and the type of f wave in electrocardiogram were all the influencing factors.