持续性与阵发性心房颤动导管射频消融肺静脉电隔离的抗凝治疗

目的探讨持续性心房颤动(简称房颤)患者导管射频消融肺静脉电隔离前后的抗凝治疗。方法2004年7月到2006年1月连续收治行射频消融治疗的持续性房颤64例,导管射频消融前需华法林抗凝治疗的阵发性房颤患者84例。所有患者术前华法林抗凝治疗使国际标准比率2.0~3.0维持至少3周。术中完成房间隔穿刺后,静脉给予肝素5000~8000U或75~100U/kg,以后每小时追加1000U或12U/kg。术后华法林抗凝治疗至少3个月。结果持续性房颤患者中1例术中心腔内超声发现消融时消融导管顶端血栓形成,术后无血栓栓塞表现,3例术后出现血栓栓塞表现,血栓栓塞发生率4.7%。阵发性房颤患者中未见血栓形成和栓塞表现。两组病例血栓形成和栓塞比较有显著差异(4/64vs0/84,P=0.033)。结论持续性房颤患者行导管射频消融肺静脉电隔离术易血栓形成和栓塞,应加强术中及术后肝素抗凝治疗。

Anticoagulation therapy in patients with persistent and paroxysmal atrial fibrillation who undergo circumferential pulmonary vein isolation

Objective The efficacy of anticoagulation therapy in patients with persistent and paroxysmal atrial fibrillation (AF) who underwent pulmonary vein isolation was evaluated. Methods Circumferential pulmonary vein isolation was performed in 64 consecutive persistent AF patients (42 men, age 55.5±7.7 years) and in 84 consecutive paroxysmal AF patients who needed warfarin anticoagulation (53 men, age 52.4±6.8 years). Anticoagulant with warfarin was administrated in all patients at least 3 weeks before and 3 months after ablation with INR 2.0～3.0. Intravenous heparin was administered after the atrial septum puncture with a dose of 5 000～8 000 U or 75～100 U/ Kg, followed by 1 000 U or 12 U/ kg per hour. Results One patient was found thrombus formation during ablation and three patients experienced thromboembolism after the procedure in persistent AF patients. In contrast, no thromboembolic event was observed in any of the paroxysmal patients (4/ 64 vs 0/ 84, P= 0.033). Conclusions Thromboembolic event related to the pulmonary vein isolation procedure is more common in patients with persistent AF, it needs the intensified dose of heparin during the procedure.