阵发性心房颤动和持续性心房颤动导管射频消融术患者心脏压塞发生情况的比较研究

Occurrence of cardiac tamponade associated with radiofrequency ablation in patients with paroxysmal atrial fibrillation and chronic atrial fibrillation

目的分析阵发性心房颤动(PAF)和持续性心房颤动(CAF)对导管射频消融术发生心脏压塞的影响。方法回顾性收集2013年1月至2016年12月首都医科大学附属北京安贞医院心房颤动中心首次行心房颤动导管射频消融术的5 313例患者的围术期资料,其中PAF患者3 295例,CAF患者2 018例。分析心房颤动类别与心脏压塞发生风险的关系。结果 PAF组和CAF组心脏压塞发生率比较[0. 9%(29/3 295)比0. 6%(12/2 018)],差异无统计学意义(P=0. 248)。2组患者的心脏积液引流量比较差异无统计学意义(P=0. 763)。8例(27. 6%)延迟心脏压塞均发生在PAF组,1例(8. 3%) CAF组患者行急诊开胸心脏修补术。进一步分层分析显示,在男性、口服抗凝药物、左心房内径<40 mm、左心室射血分数<64%、手术时间≥120 min的患者中,CAF患者发生心脏压塞的风险明显低于PAF患者(比值比=0. 403、0. 458、0. 397、0. 187、0. 423,均P <0. 05)。结论 CAF不增加导管射频消融术心脏压塞的风险。

Objective To explore the impact of radiofrequency ablation treating paroxysmal atrial fibrillation(PAF)and chronic atrial fibrillation(CAF)on cardiac tamponade.Methods A total of 5 313 patients with atrial fibrillation who had radiofrequency ablation for the first time in Beijing Anzhen Hospital,Capital Medical University between January 2013 and December 2016 were retrospectively analyzed.There were 3 295 cases of PAF and 2 018 cases of CAF.Relation between type of atrial fibrillation and cardiac tamponade was analyzed.Results Incidence of cardiac tamponade showed no significant difference between PAF and CAF patients[0.9%(29/3 295)vs 0.6%(12/2 018)](P=0.248).Volume of pericardial draining was similar between them(P=0.763).Eight cases(27.6%)of delayed cardiac tamponade occurred in PAF patients.One CAF patient(8.3%)required urgent cardiac surgery repair.Stratified analysis revealed that male,oral anticoagulants,left atrial diameter<40 mm,left ventricular ejection fraction<64%and operative time≥120 min had lower risk of cardiac tamponade in CAF group compared to those in PAF group(odds ratio=0.403,0.458,0.397,0.1870.423;all P<0.05).Conclusion CAF does not increase the risk of cardiac tamponade during ablation procedure.