摘要
目的探讨老年患者行二代冷冻球囊消融(CBA)治疗心房颤动(房颤)的安全性和有效性。方法连续纳入2016年8月至2018年12月于北部战区总医院应用二代冷冻球囊行肺静脉电隔离(PVI)的房颤患者共760例,并对这些患者进行回顾性分析,随访记录各年龄人群围术期并发症及术后房颤复发率。对其中≥75岁的老年组患者与年龄<75岁的按1∶2倾向评分相匹配的对照组患者进行围术期并发症及术后复发率的进一步比较。结果将有完整随访资料的748例房颤患者按年龄分组。各年龄组复发率:中青年组(年龄≤44岁)34.7%(25/72),中年组(年龄45~59岁)29.2%(78/267),年轻老年组(年龄60~74岁)32.2%(119/369),老年组(年龄≥75岁)32.5%(13/40),差异无统计学意义。对老年组患者进行1∶2倾向性评分匹配对照组进行分析,其中老年组37例,对照组74例。70.3%(26/37)的老年组患者术后无房颤/房性心动过速(房速)/心房扑动(房扑)复发,67.6%(50/74)的对照组患者无复发,差异无统计学意义。两组术中均未出现严重并发症。老年组中7例(18.9%,7/37)患者出现迷走神经反应,对照组中20例(27.0%,20/74)患者出现迷走神经反应,两组间差异无统计学意义。结论二代冷冻球囊行房颤PVI治疗老年患者(年龄≥75岁)是一种安全有效的方法,其复发率、术中并发症、手术时间及术中X线曝光量等与75岁以下人群相比差异无统计学意义。
Objective To investigate the safety and efficacy of the second-generation cryoballoon ablation(CBA)in the treatment of atrial fibrillation(AF)in elderly patients.Methods A total of 760 patients with AF who underwent pulmonary vein isolation(PVI)with CBA in General Hospital of Northern Theater Command from August 2016 to December 2018 were enrolled.These patients were analyzed retrospectively.Perioperative complications and postoperative recurrence rate of AF in all age groups were recorded.The related data in patients≥75 years(elderly group,n=37)were analyzed and compared with those who matched the propensity score in patients<75 years(control group,n=74).The perioperative complications and postoperative recurrence rate of AF were further compared.Results Seven-hundred and forty-eight patients with AF who had complete follow-up data,were divided into four groups according to age.The recurrence rate of AF was 34.7%(25/72 patients)in the young group(age≤44),29.2%(78/267 patients)in the middle-aged group(age:45-59),32.2%(119/369 patients)in the presenile group(age:60-74),and 32.5%(13/40 patients)in the senile group(age≥75),respectively.There was no statistical difference in the recurrence rate among the four groups.Among the senile group patients who matched the propensity score with the control group,the success rates without AF,atrial tachycardia and atrial flutter were 70.3%(26/37 patients)in the senile group and 67.6%(50/74 patients)in the control group(P>0.05).There were no severe perioperative complications in both groups.Vagal reaction occurred in 7(18.9%,7/37)in the elderly group and 20(27.0%,20/74)in the control group.There was no significant difference between the two groups.Conclusion Catheter ablation using the second-generation cryoballoon in the treatment of AF is a safe and effective method for elderly patients over 75 years old.There are no significant differences in recurrence rate of AF,perioperative complications,procedure time and X-ray exposure between patients over and under 75 years old.
作者
王辰元
代玙璠
梁明
杨桂棠
孙鸣宇
金志清
丁建
张萍
王祖禄
韩雅玲
Wang Chenyuan;Dai Yufan;Liang Ming;Yang Guitang;Sun Mingyu;Jin Zhiqing;Ding Jian;Zhang Ping;Wang Zulu;Han Yaling(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《中华心律失常学杂志》
2021年第4期332-336,共5页
Chinese Journal of Cardiac Arrhythmias
基金
国家重点研发计划(2016YFC0900904,2017YFC1307800)
全军医学科技青年培育计划拔尖项目(17QNP035)。
关键词
心房颤动
导管消融术
二代冷冻球囊
老年患者
Atrial fibrillation
Catheter ablation
Second-generation cryoballoon
Elderly patients
