摘要
目的分析导管消融术治疗老年持续性心房颤动的疗效和术后复发的独立危险因素。方法纳入2019年1月至2021年12月于解放军总医院第一医学中心心血管内科接受导管消融术的持续性心房颤动患者194例,根据年龄分为老年组99例(≥60岁)及非老年组95例(<60岁)。比较2组患者手术特征、术后并发症及复发情况,分析老年组患者术后复发的独立危险因素。结果老年组年龄、B型钠尿肽、高血压、冠心病、CHA_(2)DS_(2)-VASc评分及HAS-BLED评分高于非老年组,男性、估算肾小球滤过率低于非老年组(P<0.05,P<0.01)。老年组左心房纤维化比例高于非老年组(30.3%vs 8.4%,P=0.001)。老年组术后出现1例心包积液,2例穿刺部位血肿,均经治疗后好转。老年组与非老年组术后1年成功率比较无显著差异(71.7%vs 69.5%,P=0.763);老年组与非老年组空白期复发率比较无显著差异(21.2%vs 21.1%,P=0.981)。心房颤动持续时间(HR=1.020,95%CI:1.007~1.032,P=0.002)和空白期复发(HR=6.781,95%CI:3.078~14.935,P=0.001)是老年组患者术后复发心房颤动的独立危险因素。结论导管消融术治疗老年持续性心房颤动安全有效,心房颤动持续时间长和空白期复发的老年患者术后1年内更容易出现复发。
Objective To analyze the outcomes of catheter ablation for persistent atrial fibrillation(AF)and the independent risk factors for its recurrence in the elderly.Methods A total of 194 patients with persistent AF who underwent catheter ablation at our department from January 2019to December 2021were enrolled in this study.They were divided into elderly group(≥60 years old,99cases)and non-elderly group(<60years old,95cases).Their surgical characteris-tics,postoperative complications and recurrence were compared between the two groups,and the independent risk factors for postoperative recurrence were analyzed in the elderly group.Results Advanced age,higher B-type natriuretic peptide,larger proportions of hypertension and coronary heart disease,and increased CHA_(2)DS_(2)-VASc and HAS-BLED scores,while lower male ratio and estimated glomerular filtration rate were observed in the elderly group than the non-elderly group(P<0.05,P<0.01).The elderly group had a higher proportion of left atrial fibrosis than the non-elderly group(30.3%vs 8.4%,P=0.001).Postoperative complications in the elderly group in-cluded 1case of pericardial effusion and 2cases of hematoma at the puncture site,and all of these were improved after treatment.There were no significant differences in the 1-year success rate(71.7%vs 69.5%,P=0.763)or recurrence rate during blanking period(21.2%vs 21.1%,P=0.981)between the elderly and non-elderly groups.AF duration(HR=1.020,95%CI:1.007-1.032,P=0.002)and recurrence during blanking period(HR=6.781,95%CI:3.078-14.935,P=0.001)were independent risk factors for postoperative recurrence in the elderly group.Conclu-sion Catheter ablation is safe and effective in the treatment of persistent AF in the elderly.The elderly patients with long duration of AF and recurrences during blanking period are more likely to experience recurrences within 1year after ablation.
作者
孙瑜
黄金焕
谢鹏
国建萍
苑洪涛
时向民
郭红阳
黄亚
单兆亮
Sun Yu;Huang Jinhuan;Xie Peng;Guo Jianping;Yuan Hongtao;Shi Xiangmin;Guo Hongyang;Huang Ya;Shan Zhaoliang(Department of Cardiovascular Diseases,First Medical Center,Chinese PLA General Hospital,Beijing100853,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第3期267-270,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
军队保健专项科研课题(17BJZ08)。
关键词
心房颤动
导管消融术
危险因素
心房颤动持续时间
atrial fibrillation
catheter ablation
risk factors
duration of atrial fibrillation
