心房颤动导管射频消融术中预防左房食管瘘的进展

心房颤动导管射频消融术后左房食管瘘是一种发生率极低却极为严重的并发症,目前只有个案报道。由于左房与食管的解剖关系,可采用选择较低能量、远离食管的消融线、影像学技术以及食管温度的实时监测等方法加以预防。     

心房颤动射频消融术后心包积液的处理及危险因素分析

目的 探讨心房颤动(房颤)患者导管射频消融术后发生心包积液的处理并分析其相关危险因素.方法 156例房颤患者[男108例,女48例,阵发性房颤114例,平均年龄(57.6±11.3)岁]在三维标测系统及环状标测电极导管指导下行射频消融治疗[包括环肺静脉电隔离、线性消融及(或)碎裂电位消融],记录消融过程、部位、时间等因素,对术后证实出现心包积液的患者根据不同情况(心脏压塞或单纯心包积液)进行不同处理,并门诊随访心脏超声等.对可能影响术后出现单纯心包积液的因素进行分析.结果 所有156例患者均完成肺静脉电隔离,共有16例(10.3%)出现心包积液,其中1例(0.6%)术后即刻出现心脏压塞,予心包穿刺后开胸探查抢救好转,随访18个月无特殊;另15例(9.6%)术后出现少量心包积液但无心脏压塞表现(单纯心包积液组),经保守治疗后好转,其中6例患者的心包积液在术后3个月消失,而另外9例则在术后6个月消失.单因素分析发现,单纯心包积液组与无心包积液组在性别组成(P<0.01)、有无行冠状静脉窦消融(P=0.026)、有无行碎裂电位消融(P=0.037)、有无行上腔静脉消融(P=0.041)等方面差异有统计学意义.Logistic多因素回归分析发现,女性[B=3.594,exp(b)=36.4,95%CI:4.2-312.1,P=0.001]、行冠状静脉窦消融[B=2.419,exp(b)=11.2,95%CI:1.0～124.6,P=0.049]是术后出现单纯心包积液的独立危险因素.结论 房颤射频消融术后心包积液的发生率较高,但绝大部分并不出现心脏压塞,可经保守治疗得到改善,而不需要进一步有创治疗.女性及行冠状静脉窦消融是术后出现单纯心包积液的独立危险因素,房颤射频消融时应谨慎对待该部位的消融,以减少术后心包积液的发生.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

心房颤动射频消融术中出现规律性快速性房性心律失常的预测因素

目的：分析心房颤动（简称房颤）经导管射频消融术中出现心房扑动、房性心动过速等规律性快速性房性心律失常（RATs）的预测因素。方法：首次行经导管射频消融治疗的497例房颤患者（阵发性房颤333例,持续性和（或）永久性房颤164例）在三维标测系统及环状标测电极导管指导下行经导管射频消融治疗（包括环肺静脉电隔离、线性消融和（或）碎裂电位消融）。术中记录RATs的发生情况,并分析RATs的可能影响因素。结果：术中共有163例患者[32．8％;阵发性房颤92例,持续性和（或）永久性房颤71例]出现195种RATs,持续性和（或）永久性房颤术中RATs的发生率显著高于阵发性房颤（43．3％比27．6％,P〈0．001）。单因素分析发现心脏外科术后（P〈0．001）、术前有RATs（P=0．010）、持续性和（或）永久性房颤（P〈0．001）、左房内径增大（P〈0．001）、左室射血分数降低（P=0．018）是房颤术中出现RATs的影响因素。Logistic多因素回归分析发现心脏外科术后[优势比（0R）=8．14,95％可信区间（CI）：I．69～39．1,P=0．0093、术前有RATsEOR=2．15,95％CI：1．35～3．42,P=0．001]、持续性和（或）永久性房颤[0R=1．71,95％CI：1．06～2．76,P=0．029]、左房内径[0R=1．04,95％CI：1．01～1．08,P=0．025]是术中出现RATs的独立预测因素。结论：房颤射频消融术中常出现RATs,心脏外科术后、术前有RATs、持续性和（或）永久性房颤、左房内径是术中出现RATs的独立预测因素。     

心房颤动导管消融术后新发左房房性心动过速和/或心房扑动的研究现状

心房颤动(简称房颤)导管消融术后新发的左房房性心动过速(简称房速)、心房扑动(简称房扑)可发生于几乎所有的房颤消融术式,电生理检查表明大部分的房速、房扑为大折返机制,另一些为局灶性房速。初次消融的消融线出现缝隙可能是出现大折返性房速、房扑的主要原因。对于这些新发的左房房速、房扑再次行消融术可取得较高的成功率。     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.