中国经导管消融治疗心房颤动注册研究-2007

目的 分析2007年我国经导管消融治疗心房颤动(房颤)工作的现状.方法 根据各家医院提供的资料,对2007年我国导管消融治疗房颤病例资料进行回顾性分析.结果 截至2008年9月5日,调查共收到40家医院提供的注册登记病例资料2620份,其中男性1719例,女性901例,平均年龄(58.5±11.2)岁.阵发性房颤77.4%,持续性房颤15.7%,长期持续性房颤6.9%.54.1%的患者合并1种或1种以上的基础心脏疾病.左心房内径(38.3±6.3)mm,左心室舒张末期内径(47.8±5.2)mm,左心室射血分数0.63±0.08.经导管消融治疗房颤的主要术式是环肺静脉消融术和环肺静脉消融加必要心房辅助线.消融能源主要为射频,占99.8%.2007年的消融成功率为80.3%,复发率为19.7%.对成功率和复发率有显著影响的因素有左心房内径、房颤类型和消融术式.术后抗心律失常药物的应用有所增多,抗凝治疗明显加强.总的并发症发生率为1.7%,无严重并发症如心房食管瘘和肺静脉狭窄发生.结论 建议在相关条件较好的医院,可将经导管消融作为症状明显的阵发性房颤的一线治疗方法. 舒张末期内径(47.8±5.2)mm,左心室射血分数0 63±0.08.经导管消融治疗房颤的主要术式是环肺静脉消融术和环肺静脉消融加必要心房辅助线.消融能源主要为射频,占99.8%.2007年的消融成功率为80.3%,复发率为19.7%.对成功率和复发率有显著影响的因素有左心房内径、房颤类型和消融术式.术后抗心律失常药物的应用有所增多,抗凝治疗明显加强.总的并发症发生率为1.7%,无严重并发症如心房食管瘘和肺静脉狭窄发生.结论建议在相关条件较好的医院,可将经导管消融作为症状明显的阵发性房颤的一线治疗方法. 舒张末期内径(47.8±5.2)mm,左心室射血分数0 63±0.08.经导管消融治疗房颤的主要术式是环肺静脉消融术和环肺静脉消融加必要心房辅助线.消融能源主要为射频,占99     

中国经导管消融治疗心房颤动注册研究-2008

目的分析2008年我国经导管消融治疗心房颤动（房颤）工作的状况。方法根据房颤注册研究网上平台获得的资料,对2008年我国经导管消融治疗房颤的病例资料进行回顾性分析。结果截至2010年10月5日,调查共收到53家医院提供的注册登记病例资料2808份,其中男1946例,女862例,平均年龄（57．4±11．4）岁。阵发性房颤占71．5％,持续性房颤占22．8％,持久性房颤占5．7％。47．2％的患者合并1种或1种以上的基础心脏疾病。左心房直径（40．6±11．7）mm,左心室舒张末期内径（48．4±5．4）mm,左心室射血分数0．63±0．08。经导管消融治疗房颤的主要术式是环肺静脉隔离术和环肺静脉隔离加必要心房辅助线,消融能源全部为射频。2008年总的消融术成功率为82．1％,复发率为17．9％,对成功率和复发率有显著影响的因素有左心房直径、房颤类型和消融术式。总的并发症发生率为1．7％,严重并发症如心脏压塞和肺静脉狭窄的发生率为0．74％,无心房食管瘘的发生。结论建议在相关条件较好的医院,可将经导管消融作为无基础心脏疾病的阵发性房颤的一线治疗方法。     

中国经导管消融治疗心房颤动注册研究-2006

目的 分析2006年我国经导管消融治疗心房颤动(房颤)工作的现状.方法 2007年3月向全国开展经导管消融治疗房颤的医院发出注册登记表,8月收回并汇总.根据各家医院提供的资料,对2006年我国经导管消融治疗房颤病例资料进行回顾性分析.结果 截至2007年8月20日,本次调查共收到43家医院有效的注册登记表2160份(2006年1月1日至2006年12月31日经导管消融治疗的房颤病人),其中男性1495例,女性665例,平均年龄(56.3±11.8)岁.阵发性房颤77.7%,持续性房颤占15.1%,永久性房颤占7.2%.47.9%的患者合并1种或1种以上的基础心脏疾病,伴左心房血栓的患者占0.1%.左心房直径(38.8±6.6)mm,左心室舒张末期内径(48.6±5.2)mm,左心室射血分数0.64±0.08.经导管消融治疗房颤的术式主要有4种(1)Haissaguerre等的节段性肺静脉隔离术;(2)Pappone等的环肺静脉隔离术;(3)Nademanee等的碎裂电位消融术;(4)姚焰等的步进式个体化心房线性消融术.消融能源中,射频占99.4%,超声和冷冻共占0.75%.2006年的远期成功率为76.3%,即刻成功率为92.3%,复发率为16.0%,失败率为7.7%.对成功率和复发率有显著影响的因素有,左心室舒张末期内径、房颤类型、消融术式和消融终点等.术后抗心律失常药物的应用与术前无明显改变,但使用华法林进行抗凝治疗明显加强.消融成功者中有65.0%的患者仍然服用抗心律失常药物,有78.0%的患者仍然服用抗凝药物.总的并发症发生率为4.7%,严重并发症如心脏压塞、食管心房瘘和肺静脉狭窄仅0.8%.结论 建议在相关条件较好的医院,可将经导管消融作为无基础心脏疾病的阵发性房颤的一线治疗方法.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究10年回顾

目的 分析我同经导管消融治疗心房颤动(房颤)10年的发展历程.方法 根据参加注册医院提供的资料,对1998年至2007年我国经导管消融治疗房颤的病例资料进行同顾性分析.结果 1998年至2007年我国经导管消融治疗房颤的患者病例数快速增加,从1998年的11例增至2007年的2620例.10年里患者年龄、持续性房颤和长期持续性房颤的比例、合并基础疾病及在心房内径增大的患者比例逐年增加.经导管消融治疗房颤的主要术式是环肺静脉消融术和节段性肺静脉消融术.消融能源主要为射频.标测系统发展迅速,Carto应用广泛.消融总成功率为77.1%,复发率为22.9%.对成功率和复发率有显著影响的因素有年龄、性别、合并基础疾病、左心房内径、左心室舒张末内径、房颤类型和消融术式.消融后抗心律失常药物的应用明显减少,但抗凝治疗加强.并发症发生率为5.3%,主要是皮下血肿和心脏压塞,严重并发症心房食管瘘仅1例.结论 建议在综合条件较好的医院,可以将经导管消融作为症状明显的阵发性房颤的一线治疗方法.     

Gender-related differences in catheter ablation of atrial fibrillation.

AIMS: Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men. A catheter-based strategy is therefore widely attractive, but the impact of gender on catheter ablation (CA) of AF remains undefined. METHODS AND RESULTS: We included 221 consecutive patients (150 men) who underwent CA of drug-refractory AF. Gender differences in clinical presentation and outcomes were compared. Women were older (P = 0.002), had a longer history of AF (P = 0.04), and were more likely to have hypertension (P = 0.04). Moreover, a concomitant valvular heart disease tended to be more common in women (32.4 vs. 23.3%; P = 0.28) and left atrium dimensions were significantly larger (P = 0.003). However, acute success rate and complications rate were similar between genders. After 22.5 +/- 11.8 months of follow-up, the overall freedom from arrhythmia recurrences was similar (83.1 vs. 82.7% in men), and a similar improvement in SF-36 quality of life scores was achieved in both groups. CONCLUSION: Women are referred for AF ablation later with a more complex clinical pre-operative presentation. Despite this higher risk profile in women, no differences were detected in clinical outcomes. Our findings indicate that CA of AF appears to be safe and effective in women as in men.     

阵发性心房颤动经导管射频消融治疗评价

目的　探讨经导管射频消融治疗阵发性心房颤动 (房颤 )的安全性和有效性。方法　 74例发作频繁、药物治疗无效的阵发性房颤 ,前 5 0例的消融靶点为房颤特异性早搏或房颤的起源部位 ,消融终点为自发和诱发的房颤特异性早搏或房颤消失 (终点 1) ;后 2 4例的消融靶点为致心律失常性肺静脉的开口部 ,消融终点为该肺静脉的肺静脉电位消失 (终点 2 )。结果　共发现 111个异位灶 ,行76次消融术 ,有 5 8例 (78 4% )达到消融终点。随访 1～ 31(12 9± 6 6 )个月 ,2 3例 (31 1% )消融成功 ,可以无需药物而维持窦性心律。术中达到消融终点者的成功率为 39 7% (2 3例 / 5 8例 ) ,其中达终点 1者为 34 1% (15例 / 44例 ) ,达终点 2者为 5 7 1% (8例 / 14例 )。并发症 :无症状的单支肺静脉狭窄 5例(6 8% )、气胸 1例 (1 4% ) ,均发生于本组的前 30例中。结论　经导管射频消融治疗阵发性房颤较为安全 ,但成功率尚待提高 ,目前可用于部分发作频繁、症状严重、而且药物治疗无效的患者。     

阵发性房颤射频消融术后空白期内房性心律失常与房颤远期复发的关系

目的 探讨阵发性房颤射频消融术后3个月（“空白期”）内房性心律失常的发作趋势与远期复发的关系.方法 入选在我院接受首次环肺静脉电隔离射频消融术的阵发性房颤患者50例,并于术后3个月内每月行24h动态心电图检查,同时进行术后定期临床随访和监测12个月.根据术后第12个月体表心电图、24h动态心电图监测及临床随访结果,分为房颤复发组和无复发组,比较复发组患者与无复发组患者术后3个月内房性心律失常发生率及随着时间推移两组房性心律失常的发作趋势.结果 术后第12个月体表心电图及24h动态心电图统计结果显示,房颤复发率为36.0％（18/50）,所有心电图中出现快速型房性心律失常心电图为26.9％,其中房颤20.2％、房扑2.0％、房速4.7％;房性早搏20.1％;窦性心动过缓2.0％.复发组患者术后3个月内房性心律失常的发生率高于无复发组（41.1％比10.2％,P＜0.05）,复发组患者术后3个月内房性心律失常的发生率维持在较高水平（术后3个月分别为44.4％、41.8％、38.5％,P＞0.05）.无复发组患者术后3个月可出现房颤复发,随着时间推移房性心律失常的发生率呈降低趋势（术后3个月分别为18.7％、10.5％、4.4％,P＜0.01）.结论 早期复发不能代表消融失败和晚期复发,但早期房性心律失常发作频繁,则晚期房颤复发的危险性增加.     

进一步推进我国导管消融治疗心房颤动的临床研究

目前,心房颤动（房颤）治疗的研究方向主要有两个,一是导管消融,电生理学家力图通过不断改进消融术式,获取更好的消融效果,以期达到最终根治房颤的目的;二是药物治疗,许多药理学家则希望研制出副作用小、见效快、能长期抑制房颤的抗心律失常药物（AAD）,部分对导管消融治疗房颤效果有疑虑的临床医师也对此抱有很大希望。     

阵发性心房颤动导管消融的远期随访研究

目的 观察阵发性心房颤动(房颤)导管消融远期的成功率、抗凝或抗栓治疗和栓塞事件及抗心律失常药物治疗情况.方法 回顾2000年1月至2004年12月连续住院的症状明显、药物治疗无效的阵发性房颤并行导管消融治疗的患者106例.所有患者均在环状标测电极(Lasso)引导下进行肺静脉节段性电隔离.术后通过24 h的Holter、体表心电图、话和书信进行长期随访,观察房颤复发、抗凝或抗栓治疗和栓塞事件、抗心律失常药物治疗及死亡等情况.结果 成功随访97例,失访9例.随访病例中,男性65例,年龄(54.8±11.2)岁.平均随访(60.7±11.8)个月,3例因恶性肿瘤死亡.其余94例中,68例(72.3%)维持窦律(窦律组),26例(27.7%)房颤复发(复发组),其中8例(8.5%)为晚期复发.窦律组56例(82.4%)停用抗凝或抗栓治疗,没有发生栓寒事件.复发组中仅1例华法林抗凝,11例服用阿司匹林,其中2例发生脑栓塞;其余14例(53.8%)停用抗凝或抗栓治疗,1例发生脑栓塞.复发组栓塞发生率明显高于窦律组(P<0.01).窦律组停用抗心律失常药物治疗的比率明显高于复发组(80.9%比56.0%,P<0.05).结论 阵发性房颤导管消融有较高远期成功率,远期复发率低;房颤根治者远期可以停用抗凝或抗栓治疗,且明显减少栓塞风险,并通过减少该类患者抗心律失常药物治疗,相应提高生活质量.