肾动脉去神经术对提高持续性房颤射频消融术后无复发事件生存率的初步结果

发布时间：2018-04-27 08:25

本文选题：肾动脉去神经术 + 持续性心房颤动　；参考：《浙江大学》2015年硕士论文

【摘要】：背景：房颤经导管射频消融术是目前认为治疗药物难治性房颤的有效方法之一,但复发率仍然较高(阵发性房颤复发率：20-30%,持续性房颤：30-40%。因此,如何提高房颤消融患者的无复发事件生存率仍有待更多的研究。肾动脉去神经术是近年来新出现的用来治疗顽固性高血压的非药物的方法,国外已有小样本研究发现肾动脉去神经术能进一步提高房颤射频消融的成功率。本研究通过比较对持续性房颤合并高血压的患者分别进行房颤射频消融+肾动脉去神经术和单纯房颤射频消融术后房颤的近、中期复发率,探讨肾动脉去神经术对提高房颤消融患者的无复发事件生存率的安全性及有效性。方法：连续6例邵逸夫医院的持续性房颤合并高血压患者入房颤射频消融+肾动脉去神经术组(A组),连续选取24名同时期入院的持续性房颤合并高血压患者入单纯房颤射频消融术组(B组)。A组行常规持续性房颤射频消融术及肾动脉去神经术,B组行常规持续性房颤射频消融术,对两组患者术后进行1月,3月,6月,9月,12月的随访,比较两组之间术后近期及中期的复发率及血压变化。结果：所有接受房颤射频消融术及肾动脉去神经术的患者均未出现手术相关并发症。A组6例患者中有1例房颤复发(1/6)复发率为16.7%,B组24例患者中有8例房颤复发(8/24),复发率为33.3%,(P=0.04)。A组收缩压手术前平均142.7+11.0mmHg,手术后平均131.0+9.5mmHg,(P0.05),平均下降绝对值为11.7mmHg,有显著性差异,术后3月,术后6月收缩压较术前下降但无统计学意义。A组舒张压手术前平均96.2+2.6nmHg,手术后平均87.5+4.9mmHg (P0.05),术后3月平均81.2+6.9mmHg(P0.05),术后6月平均73.7+10.3mmHg (P0.05). 结论：肾动脉去神经术或许并不额外增加房颤射频消融术的风险,并可改善持续性房颤射频消融术后的近中期无复发事件生存率,对舒张压有积极的影响,对于收缩压无明显作用。
[Abstract]:Background: radiofrequency ablation of atrial fibrillation via catheter is considered to be one of the effective methods for the treatment of refractory atrial fibrillation, but the recurrence rate is still high (recurrent rate of paroxysmal atrial fibrillation: 20-30, persistent atrial fibrillation: 30-40). Therefore, more research is needed on how to improve the recurrence-free survival rate in patients with atrial fibrillation ablation. Renal artery denervation is a new non-drug method for the treatment of refractory hypertension in recent years. A small sample of studies have found that renal artery denervation can further improve the success rate of radiofrequency ablation of atrial fibrillation. In this study, we compared the recurrence rates of atrial fibrillation in patients with persistent atrial fibrillation complicated with hypertension by radiofrequency ablation of renal artery and simple radiofrequency ablation of atrial fibrillation. To investigate the safety and efficacy of renal artery denervation in improving recurrence-free survival rate in patients with atrial fibrillation ablation. Methods: six consecutive patients with persistent atrial fibrillation complicated with hypertension were treated with radiofrequency ablation of renal artery in group A and 24 patients with persistent atrial fibrillation complicated with hypertension were selected in the same period. Radiofrequency ablation of pure atrial fibrillation was performed in group B and renal artery denervated respectively in group B and radiofrequency ablation of atrial fibrillation were performed in group B and group B respectively, and group B received conventional radiofrequency ablation of atrial fibrillation, and group B received conventional radiofrequency ablation of atrial fibrillation. The patients in the two groups were followed up for 1 month, 3 months, 6 months, 9 months and 12 months after operation. The recurrence rate and blood pressure were compared between the two groups. Results: all the patients undergoing radiofrequency ablation of atrial fibrillation and renal artery denervation had no operative complications. In group A, the recurrence rate of atrial fibrillation was 1 / 6 out of 6.) the recurrence rate of atrial fibrillation in group B was 8 out of 24 patients in group B. The recurrence rate of group A was 142.7 卤11.0mmHg before operation and 131.0 9.5mmHgG after operation, and the absolute value of the decrease was 11.7mmHg. there was a significant difference between the two groups. Three months after operation, systolic blood pressure (SBP) in group A was significantly lower than that before operation. The mean diastolic blood pressure (DBP) in group A was 96. 2. 6 nmHg before operation, 87. 5 4.9mmHg / g after operation, 81. 29 mm / g P0. 05 and 73. 7 10.3mmHg / g P0. 05 卤0. 05% respectively in 3 months after operation, and 7. 7 10.3mmHg / g in 6 months after operation. Conclusion: renal artery denervation may not increase the risk of radiofrequency ablation of atrial fibrillation, and can improve the survival rate of recurrent events in the near to middle term after radiofrequency ablation of persistent AF, and has a positive effect on diastolic blood pressure. It has no obvious effect on systolic blood pressure.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.75

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