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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
张颢,韩莉,李真,赵子明,高连君,常栋,肖宪杰,张荣锋,杨延宗,尹晓盟,夏云龙.导管射频消融治疗高龄心房颤动患者的临床评价[J].中华老年多器官疾病杂志,2017,16(12):929~933
导管射频消融治疗高龄心房颤动患者的临床评价
Clinical evaluation of radiofrequency catheter ablation in treatment of atrial fibrillation in the elderly
投稿时间:2017-07-12  修订日期:2017-08-03
DOI:10.11915/j.issn.1671-5403.2017.12.216
中文关键词:  心房颤动;老年人;导管消融
英文关键词:atrial fibrillation; aged; catheter ablation
基金项目:
作者单位E-mail
张颢 大连医科大学附属第一医院心律失常科,大连 116011  
韩莉 大连医科大学附属第一医院心律失常科,大连 116011  
李真 大连医科大学附属第一医院心律失常科,大连 116011  
赵子明 大连医科大学附属第一医院心律失常科,大连 116011  
高连君 大连医科大学附属第一医院心律失常科,大连 116011  
常栋 大连医科大学附属第一医院心律失常科,大连 116011  
肖宪杰 大连医科大学附属第一医院心律失常科,大连 116011  
张荣锋 大连医科大学附属第一医院心律失常科,大连 116011  
杨延宗 大连医科大学附属第一医院心律失常科,大连 116011  
尹晓盟 大连医科大学附属第一医院心律失常科,大连 116011 dr.yinxm@163.com 
夏云龙 大连医科大学附属第一医院心律失常科,大连 116011 yunlong_xia@126.com 
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中文摘要:
      目的 评价高龄心房颤动(AF)患者接受导管射频消融治疗的有效性和安全性。方法 纳入2008年1月至2014年8月在大连医科大学附属第一医院行房颤射频消融(RA)的877例患者,按年龄分为老年组(≥75岁)68例、年轻老年组(65~74岁)320例及对照组(<65岁)489例。记录3组患者的临床资料,分析对比3组患者术中并发症、手术时间、X线曝光时间,比较术后血栓栓塞率、再住院率、二次手术率、术后抗心律失常药物服用率以及术后缓慢心室率比例。消融成功的定义:术后心电图或动态心电图未再出现持续时间超过30 s的房颤。采用SPSS 19.0统计软件,根据数据类型分别采用χ2检验、方差分析或LSD检验进行分析。应用Kaplan-Meier分析分别比较持续性AF和阵发性AF不同年龄患者的导管消融成功率。结果消融过程及安全性评价:3组患者术中并发症(5.9% vs 3.1% vs 2.9%)、手术时间[(196.65±34.45) vs (196.03±40.02) vs (194.36±37.89)min]、X射线曝光时间[(19.81±6.73) vs (19.44±6.45) vs (18.69±6.00)min],差异均无统计学意义。疗效评价:3组患者随访(21.45±6.31)个月,其术后血栓栓塞率(4.4% vs 3.4% vs 2.5%)、再住院率(23.5% vs 22.2% vs 18.0%)及二次手术率(11.8% vs 12.8% vs 12.3%),差异无统计学意义。但是,老年组患者在术后长期使用抗心律失常药物的比例相对较低(13.2% vs 29.4% vs 20.0%,P=0.001),术后动态心电图出现缓慢心室率的比例较高(23.5% vs 15.6% vs 12.3%,P=0.033)。Kaplan-Meier生存分析结果显示持续性AF和阵发性AF不同年龄患者的导管消融成功率差异无统计学意义。结论 老年心房颤动患者的导管消融成功率和安全性与年轻患者相似。
英文摘要:
      Objective To investigate the efficacy and safety of radiofrequency catheter ablation in the very old patients of atrial fibrillation (AF). Methods A total of 877 AF patients who underwent catheter ablation in our hospital from January 2008 to August 2014 were recruited in this study. According to their age, they were divided into very old group (≥75 years old, n=68), aged group (65-74 years old, n=320) and control group (<65 years old, n=489). The clinical data were collected and analyzed. The incidence of intra-operative complications, operation time, X-ray exposure time, post-operative thromboembolic rate, readmission rate, reoperation rate, post-operative administration rate of antiarrhythmia drugs and slow heart rate were compared among the groups. Successful ablation was defined as having no >30 s AF in any 24-hour holter monitoring during the follow-up period. SPSS statistics 19.0 was used to perform the statistical analysis. Chi-square test, analysis of variance, or LSD test was employed for different data types. Kaplan-Meier survival analysis was adopted to compare the success rate of ablation between the persistent AF and paroxysmal AF patients at different ages. Results In the evaluation of ablation procedure and safety, there were no significant differences in the incidence rates of complications (5.9% vs 3.1% vs 2.9%), operation time[(196.65±34.45) vs (196.03±40.02) vs (194.36±37.89) min] and X-ray exposure time[(19.81±6.73) vs (19.44±6.45) vs (18.69±6.00)min] among the 3 groups. After a mean follow-up period of (21.45±6.31) months, no obvious differences were found in the thromboembolism rate (4.4% vs 3.4% vs 2.5%), readmission rate (23.5% vs 22.2% vs 18.0%) and reoperation rate (11.8% vs 12.8% vs 12.3%) among the 3 groups. However, the very old group had lower rate of taking antiarrhythmic drugs (13.2% vs 29.4% vs 20.0%, P=0.001) and experienced higher rate of slow heart rate in holter monitoring (23.5% vs 15.6% vs 12.3%, P=0.033) than the other 2 groups. Kaplan-Meiers survival analysis indicated that there was no difference in the success rate of ablation between the persistent AF and paroxysmal AF patients at different ages. Conclusion The success rate and safety of catheter ablation are similar between the old and young AF patients.
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