射频消融与冷冻球囊消融治疗阵发性房颤复发率对比及复发危险因素分析

发布时间：2018-07-27 09:36

【摘要】：研究背景经导管射频消融(Radiofrequency Catheter Ablation,RFCA)和冷冻球囊消融(Cryoballoon Ablations,CBA)是目前用于治疗心房颤动的两种基本方式。但是对于中国房颤患者在两种消融方式治疗效果上的对比资料较少。本研究的目的在于对比两组消融术式的复发率以及分析房颤消融术后复发危险因素。研究方法连续入选2014年1月1日至2016年6月31日因抗心律失常药物治疗无效而在阜外医院接受消融治疗的阵发性心房颤动患者共399例。其中接受RFCA治疗的患者有203例,接受CBA治疗的患者有199例。两组患者的年龄、性别比例、房颤病史时间及基础疾病的基线资料均无显著性差异。术后平均随访时间为15.0±8.0月(中位数)。首要终点事件是房颤术后3月空白期外出现心电图记录到的持续30s的房颤、房扑或房性心动过速;二次消融手术;再次服用抗心律失常药物控制不适症状。手术相关并发症亦被收集。研究结果共纳入399例阵发性房颤患者(RFCA组203,CBA组196)。两组首要终点事件的发生率分别为RFCA组69(34.0%),CBA组54(27.6%)。进行多因素(纳入模型因素为年龄、性别、心悸症状时间、BMI、高血压、LAD、术式不同)分析后发现两组无显著性差异(Log rank p=0.086)。仍与房颤复发的显著相关的危险因素包括心悸症状时间(HR=1.005;P0.001;95%CI:1.002-1.007),BMI25 kg/m2(HR=1.667;P=0.007;95%CI:1.153-2.411),高血压(HR=1.550;P=0.022;95%CI:1.065-2.257),LAD(HR=1.042;P=0.032;95%CI:1.003-1.083)。研究结论RFCA与CBA术后复发率无显著差异。高血压、BMI25kg/m2、心悸症状时间、LAD增大是房颤的独立危险因素之一。
[Abstract]:Background radiofrequency catheter ablation (Radiofrequency Catheter Ablation (Radiofrequency Catheter) and cryopreservation balloon ablation (Cryoballoon Ablation CBA) are two basic methods for the treatment of atrial fibrillation. But there is little data on the efficacy of two ablation methods in patients with atrial fibrillation in China. The aim of this study was to compare the recurrence rate of the two groups and to analyze the risk factors of recurrence after AF ablation. Methods from January 1, 2014 to June 31, 2016, 399 patients with paroxysmal atrial fibrillation (PAF) who received ablation therapy in Fuwai Hospital because of ineffective antiarrhythmic drugs were enrolled in the study. There were 203 patients treated with RFCA and 199 patients with CBA. There were no significant differences in age, sex ratio, duration of atrial fibrillation history and baseline data of underlying diseases between the two groups. The mean follow-up time was 15.0 卤8.0 months (median). The primary endpoint events were atrial fibrillation, atrial flutter or atrial tachycardia recorded by electrocardiogram (ECG) for 30 s outside the blank period of 3 months after atrial fibrillation; second ablation operation; taking antiarrhythmic drugs again to control symptoms. Surgical complications were also collected. Results A total of 399 patients with paroxysmal atrial fibrillation were included (RFCA group 203, CBA group 196). The incidence of primary endpoint events in two groups was 69 (34.0%) in RFCA group and 54 (27.6%) in CBA group. There was no significant difference in (Log rank p0.086 between the two groups after multivariate analysis (including age, sex, palpitation symptom time, hypertension and different operation methods). Significant risk factors still associated with recurrent atrial fibrillation included the duration of palpitation symptoms (HR1. 005), the duration of palpitation symptoms (HR1. 005) and the BMI25 kg/m2 (HR1. 667 P0. 007), hypertension (1. 550 P0. 022 95 CIW 1.065-2.257) and lad (HR1. 042 P0.03295CI1. 003-1.083). Conclusion there is no significant difference in recurrence rate between RFCA and CBA. Hypertension BMI 25 kg / m 2, palpitation symptom time and lad increase is one of the independent risk factors of atrial fibrillation.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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