不同性别心房颤动患者行心腔内超声指导下射频消融联合经皮左心耳封堵“一站式”手术疗效及安全性分析

Efficacy and safety of intracardiac echocardiography-guided “one-stop” procedures that combined radiofrequency catheter ablation and left atrial appendage closure in patients with atrial fibrillation in different genders

目的 探讨不同性别心房颤动患者行心腔内超声(ICE)指导下射频消融联合左心耳封堵“一站式”手术的疗效及安全性。方法 回顾性分析自2020年11月至2023年6月于北部战区总医院心血管内科行ICE指导下“一站式”手术治疗的283例心房颤动患者的临床资料。按性别将患者分为男性组(n=162)与女性组(n=121)。比较两组患者的临床特征、围术期并发症及术后随访结果。结果 两组患者年龄、CHA2DS2-VASc评分、HAS-BLED评分、左房内径、左室射血分数、肌酐清除率、胆固醇及阵发性心房颤动、吸烟史、饮酒史比例比较,差异有统计学意义(P<0.05)。男性组电复律比例、射频消融时间、总操作时间、总曝光剂量高于女性组,差异有统计学意义(P<0.05)。所有患者均成功植入左心耳封堵器,均使用Watchman封堵器,男性组使用33 mm Watchman封堵器比例多于女性组,差异有统计学意义(P<0.05)。两组患者围术期并发症发生率比较,差异无统计学意义(P>0.05)。两组患者术后3个月残余分流及器械相关血栓发生率比较,差异无统计学意义(P>0.05)。两组患者心房颤动复发率、术后相关事件发生率比较,差异无统计学意义(P>0.05)。结论 不同性别心房颤动患者有各自的临床特点,ICE指导下心房颤动导管消融术联合左心耳封堵“一站式”手术疗效及安全性无性别差异。

Objective To investigate the clinical characteristics, efficacy and safety of the “one-stop” surgery of radiofrequency ablation combined with left atrial appendage closure under the guidance of intracardiac echocardiography(ICE)in different genders.Methods A total of 283 patients with atrial fibrillation who underwent “one-stop” surgery under the guidance of ICE in General Hospital of Northern Theater Command from November 2020 to June 2023 were retrospectively analyzed, and were divided into male group(n=162)and female group(n=121)according to their gender.The clinical characteristics, perioperative complications and postoperative follow-up results of the two groups were compared.Results There were statistically significant differences in age, CHA2DS2-VASc score, HAS-BLED score, left atrial diameter, left ventricular ejection fraction, creatinine clearance rate, cholesterol and the proportion of paroxysmal atrial fibrillation, smoking history, and drinking history between two groups(P<0.05).The proportion of electrocardioversion, radiofrequency ablation time, total operation time and total exposure dose in the male group were higher than those in the female group, and the differences were statistically significant(P<0.05).The left atrial appendage occlusion devices were successfully implanted in all patients, and all included patients used Watchman occlusion devices.The proportion of 33 millimeters Watchman occlader used in male group was higher than that in female group, and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of peri-device leak and device related thrombosis at 3 months after operation between the two groups(P>0.05).There was no statistical difference in the atrial fibrillation recurrence rate between the two groups(P>0.05).There was no statistical difference in long-term complications during the follow-up period(P>0.05).Conclusion Different genders have their own clinical characteristics, and there are no gender difference in the efficacy and safety of the “one-stop” surgery of radiofrequency ablation combined with left atrial appendage closure under the guidance of ICE.