左心耳封堵术在持续性房颤患者中的预后研究

Study on Prognosis of Left Atrial Appendage Closure in Patients with Persistent Atrial Fibrillation

目的研究接受冷冻消融联合左心耳封堵术及单纯封堵的非瓣膜性持续性房颤患者的术中情况,以及远期预后的安全性与有效性。方法回顾2017年6月至2022年10月在同济大学附属第十人民医院心内科接受冷冻消融及左心耳封堵术治疗的非瓣膜性持续性房颤患者,收集并分析了住院及术后随访数据。根据联合冷冻消融和单纯封堵分为两组,并采用倾向性匹配评分法(propensity score matching,PSM)进行匹配,比较两组术中及术后不良事件随访情况。结果共290例非瓣膜性持续性房颤患者纳入研究,其中联合组161人,单封堵组129人,PSM匹配后两组各纳入患者92例。匹配后两组患者基线比较差异均无统计学意义(P>0.05)。联合组与单封堵组在围术期的并发症及后期随访结果没有显著差异(P>0.05)。经过平均49.3±20.4个月的随访,匹配前联合消融组与单独封堵组术后不良事件包括房性心律失常症状发作再入院治疗(P=0.46),心力衰竭再入院治疗(P=0.05)和脑卒中(P=0.50)的生存时间均没有显著差异(P>0.05),且PSM匹配后进一步发现两组的房性心律失常症状发作再入院治疗(P=0.88),心衰发作再入院(P=0.75)和脑卒中(P=0.98)不良事件发生率也没有显著差异(P>0.05)。结论与单纯封堵相比,冷冻消融联合左心耳封堵术在持续性房颤患者中可能同样安全,但联合术式对主要结局的改善并不显著。

Objective To investigate the safety and effectiveness of intraoperative situation and long-term prognosis of patients with nonvalvular persistent atrial fibrillation who received cryoablation combined with left atrial appendage closure and left atrial appendage closure alone respectively.Methods A retrospective collection was conducted on patients with nonvalvular persistent atrial fibrillation who underwent cryoablation and left atrial appendage closure at the Department of Cardiology,Shanghai Tenth People’s Hospital,School of Medicine,Tongji University,from June 2017 to October 2022.Hospitalization and postoperative follow-up data were analyzed.Patients were divided into two groups based on whether they received cryoablation or not,and propensity score matching(PSM)was employed for group matching.Comparison was made between the two groups regarding the subsequent monitoring of intraoperative and postoperative adverse events.Results A total of 290 patients with nonvalvular persistent atrial fibrillation were included in this study.The combined group comprised 161 individuals,while the single closure group consisted of 129 individuals.After PSM,92 patients were enrolled in each group.Baseline characteristics showed no statistically significant differences between the two groups(P>0.05).No substantial disparities were observed in terms of perioperative complications and long-term follow-up outcomes when comparing the combined group with the single closure group(P>0.05).Following a mean follow-up duration of 49.3±20.4 months,no statistically significant disparity in survival rates between the combined ablation group and the single closure group was found(P>0.05).This encompassed outcomes such as Symptomatic attack of Atrial arrhythmia rehospitalization(P=0.46),Heart failure rehospitalization(P=0.05),and Cerebral Infarction(P=0.50).Additionally,after PSM,it was further ascertained that there was no noteworthy distinction between the two groups concerning Symptomatic attack of Atrial arrhythmia rehospitalization(P=0.88),Heart failure rehospitalization(P=0.75),and Cerebral Infarction(P=0.98)(P>0.05).Conclusion In patients with persistent atrial fibrillation,the combination of cryoablation and left atrial appendage closure exhibits the same safety profiles as simple closure.Nevertheless,it does not manifest a statistically significant improvement in the primary outcome.