合并脑栓塞的房颤患者射频消融治疗的远期随访研究

发布时间：2018-06-04 13:33

本文选题：射频消融 + 心房颤动　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：评价合并脑栓塞的房颤患者经导管射频消融治疗后能否有效的降低再发缺血性脑栓塞的风险。方法：回顾2002年1月份到2013年1月份入住大连医科大学附属第一医院治疗的房颤患者共794人，从中抽取合并有缺血性脑栓塞病史并接受导管射频治疗房颤的患者共37人（设为手术组），包括男性26人，女性11人，男女比例2.6：1，年龄分布在44-77岁之间，平均年龄61.62±7.62岁，其中阵发性房颤18人（48.7%），持续性房颤19人（51.3%），CHA2DS2-VASc平均得分3.6±1.2；术前发现高血压病21人（56.8%），糖尿病8人（21.6%），充血性心力衰竭9人（24.3%），高脂血症8人（21.6%）。匹配药物节律控制治疗房颤的患者37人进行对照（设为对照组）。对照组患者均合并有缺血性脑栓塞病史，包括男性24人，女性13人，男女比例1.8：1，年龄分布在46-78岁之间，平均年龄63.54±7.40岁。其中阵发性房颤26人（70.3%），持续性房颤11人（29.7%），CHA2DS2-VASc平均得分3.9±1.4；治疗前发现高血压病20人（54.1%），，糖尿病10人（27%），充血性心力衰竭10人（27%），高脂血症10人（27%）。手术组患者平均随访时间35±27个月，对照组患者平均随访时间34±13个月，并且所有房颤患者均符合2012ESC心房颤动指南诊断标准：1）体表心电图表现为“绝对”不规则的R-R间期，即R-R间期不遵循重复模式。2）在体表ECG上没有明显的P波。在一些心电图导联中，有比较明显的规则的心房电活动，常出现在V1导联。3）心房周期（可见时），即两次心房激动之间的间期，通常是变化的，且200ms(300次每分钟[bpm])。阵发性房颤定义为房颤自行发作和终止，每次持续时间小于7天。持续性房颤指房颤发作持续时间大于7天，一般不能自行终止，需药物、直流电复律或射频消融等手段转律。所有接受导管射频消融治疗的房颤患者均为房颤发作频繁，症状明显，抗心律失常药物治疗无效或不能耐受药物的副作用，患者及家属要求或同意行射频消融术。结果：采用门诊复诊和电话的方式进行随访。手术组患者在消融术后有14名患者房颤复发，3名患者再次发生缺血性脑栓塞（包含2名房颤复发患者）；对照组患者在接受药物治疗后有31名患者房颤复发，13名患者再次发生缺血性脑栓塞（13名患者房颤全部复发），两组间脑栓塞发生率（P＜0.05），存在统计学意义。结论：（1）对合并有缺血性脑栓塞的房颤患者行导管射频消融治疗安全、有效。（2）与药物节律控制治疗房颤相比，合并缺血性脑栓塞的房颤患者在导管消融治疗后远期房颤的复发率降低，同时明显降低了缺血性脑栓塞发生的风险。
[Abstract]:Aim: to evaluate whether radiofrequency catheter ablation (RFCA) can effectively reduce the risk of recurrent ischemic cerebral embolism in patients with atrial fibrillation complicated with cerebral embolism. Methods: a total of 794 patients with atrial fibrillation admitted to the first affiliated Hospital of Dalian Medical University from January 2002 to January 2013 were reviewed. A total of 37 patients (26 males and 11 females) who had a history of ischemic cerebral embolism and received radiofrequency catheter therapy for atrial fibrillation were selected from the study group. The ratio of male to female was 2. 6: 1. The mean age was 61.62 卤7.62 years old, and the age distribution was between 44 and 77 years old, and the mean age was 61.62 卤7.62 years. There were 18 patients with paroxysmal atrial fibrillation and 19 patients with persistent atrial fibrillation. The average score of CHA2DS2-VASc was 3.6 卤1.2.Twenty one patients with hypertension were found to have hypertension before operation, 8 patients with diabetes mellitus had 21 patients with hypertension, 9 patients with congestive heart failure and 24.3 patients with hyperlipidemia, and 8 patients with hyperlipidemia were found to have hyperlipidemia. A total of 37 patients with atrial fibrillation treated with matched drug rhythms were treated as control group (control group). All the patients in the control group had a history of ischemic cerebral embolism, including 24 males and 13 females. The ratio of male to female was 1. 8: 1. The mean age was 63.54 卤7.40 years old. There were 26 patients with paroxysmal atrial fibrillation and 11 patients with persistent atrial fibrillation. The average score of CHA2DS2-VASc was 3.9 卤1.4.Twenty patients with hypertension were found to have hypertension 54.1, 10 with diabetes, 10 with congestive heart failure, 27 with hyperlipidemia and 27 with hyperlipidemia. The mean follow-up time was 35 卤27 months in the operation group and 34 卤13 months in the control group. All patients with atrial fibrillation met the diagnostic criteria of 2012ESC atrial fibrillation: 1) the surface electrocardiogram showed "absolute" irregular R-R interval. That is, R-R interval does not follow repeat mode. 2) there is no obvious P wave on ECG. In some electrocardiograms, regular atrial electrical activity, often occurring in the V1 lead. 3) atrial cycle (the interval between two atrial excitations is usually variable, and 200ms(300 times per minute [bpm]). Paroxysmal atrial fibrillation is defined as spontaneous onset and termination of atrial fibrillation, each lasting less than 7 days. The duration of persistent atrial flutter is more than 7 days, which can not be terminated by itself. It needs drugs, direct current cardioversion or radiofrequency ablation. All patients with atrial fibrillation received radiofrequency catheter ablation had frequent atrial fibrillation, obvious symptoms, ineffective or intolerable side effects of antiarrhythmic drugs, and patients and their families requested or agreed to perform radiofrequency ablation. Results: follow-up was carried out by the way of outpatient consultation and telephone. 14 patients with recurrent atrial fibrillation and 3 patients with ischemic cerebral embolism (including 2 patients with recurrent atrial fibrillation) and 31 patients with recurrent atrial fibrillation after drug therapy in the control group The incidence of cerebral embolism between the two groups was significantly higher than that in the control group (P < 0.05). Conclusion 1) radiofrequency catheter ablation is safe and effective in the treatment of atrial fibrillation with ischemic cerebral embolism. The long-term recurrence rate of atrial fibrillation in patients with ischemic cerebral embolism decreased after catheter ablation, and the risk of ischemic cerebral embolism was significantly reduced.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.75;R743.3

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