南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (10): 1415-1421.doi: 10.12122/j.issn.1673-4254.2020.10.06

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一站式手术对房颤消融成功率及心功能的影响：一项倾向评分匹配研究

朱世杰，郑慕晗，颜如玉，谭振林，赵海玉，张建武，彭 健   

  • 出版日期:2020-10-20 发布日期:2020-10-20

Success rate of one-stop procedure for atrial fibrillation ablation and its impact on cardiac function: a propensity-matched study

  • Online:2020-10-20 Published:2020-10-20

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摘要： 目的 探讨在房颤消融术的基础上加行左心耳封堵术对房颤消融成功率及患者心功能的影响。方法 回顾性纳入2015年5月~2019年5月就诊于我院同时行房颤消融术及左心耳封堵术（一站式手术）的56名患者作为病例组，并运用倾向评分匹配的方法按1∶1的比例从同时期行房颤消融术的具有高卒中风险的患者（n=375）中筛选出与一站式组在临床基线资料上匹配的房颤消融组（n=56），对比两组房性心律失常的复发率以及心功能情况，同时对比两组围术期并发症和血栓栓塞事件的发生率。结果 一站式组和房颤消融组在年龄、性别、BMI、房颤病程、类型、合并症、CHA2DS2-VASc和HAS-BLED 评分上差异均无统计学意义（P>0.05）。一站式组和房颤消融组在围术期并发症的发生率上并无差异（17.9% vs 12.5%，P=0.430），一站式组血栓栓塞事件的发生率有较房颤消融组下降的趋势（1.8% vs 3.6%），但差异无统计学意义（P=1.000）。一站式手术并不提升房颤消融的成功率（OR：1.338，95%CI：0.451~3.973，P=0.600），一站式术后患者的心功能较术前明显改善（NT-pro BNP：945.3±1401.6 pg/mL vs 1520.7±2089.1 pg/mL，P=0.010；LVEF：（60.8±7.0）% vs（58.6±7.8）%，P=0.044；左心房内径：43.9±7.5 mm vs 45.6±6.3 mm，P=0.076），但房颤消融组术后心功能的改善程度更佳（P<0.005）。结论 在房颤消融术的基础上加行左心耳封堵术具有足够的安全性，且不影响房颤消融的成功率。虽然一站式术后患者的心功能明显较术前改善，但改善程度不如房颤消融术。

关键词: 房颤, 一站式手术, 复发, 心功能

Abstract: Objective To investigate the effect of the combination of atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) on cardiac function and the success rate of AF ablation. Methods We retrospectively analyzed the data of 56 patients with AF undergoing a one-stop procedure for AF ablation and LAAC in our hospital between May, 2015 and May, 2019. Propensity score matching (PSM) at the ratio of 1∶1 was used to select 56 control patients undergoing AF ablation at high risk of stroke, for matching with the hybrid procedure group. The perioperative complications, thromboembolic events, recurrence of atrial arrhythmia and cardiac function were compared between the groups. Results The two groups of patients were comparable for age, gender, BMI, duration and type of AF, concomitant diseases, CHA2DS2-VASc and HAS-BLED scores (P>0.05). The incidence of complications did not differ significantly between the hybrid procedure group and AF ablation group (17.9% vs 12.5% , P=0.430). Compared with the control patients with AF ablation alone, the patients undergoing the hybrid procedure had a lowered incidence of thromboembolic events, but the difference was not statistically significant (1.8% vs 3.6% , P=1.000). The hybrid procedure did not improve the success rate of AF ablation (OR: 1.338, 95%CI: 0.451-3.973, P=0.600) but significantly improved the cardiac function parameters including NT-pro BNP (945.3±1401.6 pg/mL vs 1520.7±2089.1 pg/mL, P=0.010), LVEF [(60.8±7.0)% vs (58.6±7.8)%, P=0.044], and left atrial diameter (43.9±7.5 mm vs 45.6±6.3 mm, P=0.076); but the improvement of cardiac function was more obvious in the control patients undergoing AF ablation alone (P<0.039). Conclusion The combination of AF ablation and LAAC is safe but does not improve the success rate of AF ablation. The one-stop procedure can improve cardiac function of the patients, but AF ablation alone can achieve better improvement of cardiac function.

Key words: atrial fibrillation, one-stop procedure, recurrence, cardiac function