心房颤动的综合治疗——一项单中心210例心房颤动研究结果

目的:分析近几年我院心房颤动(atrial fibrillation,AF)患者,包括慢性AF、持续性AF和阵发性AF患者综合治疗及其预后情况,为将来更好地处理AF患者提供一定的参考。方法:自2002年1月至2004年6月在我院心内科住院治疗AF患者均纳入本研究,共217名,其中7名住院期间死亡,对其余210名患者进行随访,其中男性101人,女性109人,平均年龄66岁,平均随访25．5月,失访率15．7%(33/210)。以电话随访为主。结果:(1)我院AF可能的常见原因依次为高血压(42．9%)、冠心病(20．0%)和风心病(12．9%);(2)本组AF病例中不同年龄比率与年龄密切相关,年龄越大,比率越高;(3)死亡率方面,慢性AF组患者明显高于持续性AF和阵发性AF组患者;(4)76例阵发性AF患者随访中仅3名转为持续性,其余73例(96．1%)仍为阵发性AF;(5)华法林在所有AF患者中使用率仅为29．9%,其中慢性AF组患者使用率最高, 93．0%(40/43)使用华法林患者能够遵医嘱定期检查出凝血功能;华法林治疗组有3名患者发生轻中度出血,非华法林治疗组有3名患者出现脑栓塞,其中2名患者遗留肢体活动障碍;(6)14名阵发性AF患者进行了射频消融治疗,即刻成功率92．9%,远期成功率71．4%(10/14),远期有效率85．7%(12/14);(7)27名患者在随诊期间死亡,总死亡率12．9%,前三位死因为多脏器功能衰竭(33．3%)、心力衰竭(18．5%)和恶性肿瘤(11．1%)。结论:高血压是AF最常见的可能原因,条件适合者应尽可能行射频消融术根治AF,不适合射频消融术或射频消融术失败者应强调华法林抗凝治疗的重要性。

Comparison of Different Treatment Strategies in Atrial Fibrillation

Objective:Atrial fibrillation(AF)is the most common arrhythmia in the elderly.Although new methods such as abla- tion is emerging,rate control and rhythm control with antiarrhythmic drugs are still of the choice.The present study is to evaluate the outcomes of atrial fibrillation with different strategies in our hospital from January 2002 to June 2004.Methods:Two hundred and seven- teen patients aged 66 were recruited in the study including 101 male and 109 female.7 died during the hospitalization and remaining 213 were followed for 25.5 months.33 were lost during follow-up(15.7%).Results:The accompanying diseases,which may be responsible for AF in this group of patients,are hypertension(42.9%),coronary heart disease(20.0%),and rheumatic valve dis- ease(12.9%).Only few patients with paroxysmal AF become persistent(3/76),suggesting different anderlying mechanisms.Only 29.9% of all patients were anticoagulated,but 93.0% of chronic patients were anticoagulated.All patients with anticoagulation were monitored with INR.3 of patients with anticoagulation had minor bleeding.3 of patients without antieoagulation had cerebral infarction with sequelae.14 patients with paroxysmal AF received ablation procedure with an immediate success of 92.9%,and long term suc- cess of 71.4%.27 patients died during follow-up,including multi-organ failure in 33.3%,heart failure in 18.5% and malignant tumor in 11.1%.Conclusion:Hypertension was the most common co-existing problem in patients with AF.Ablation was an effec- tive method for patient with paroxysmal AF.Anticoagulation was safe for patients with AF with INR monitoring.