目的 评估无数字减影血管造影(digital subtraction angiography,DSA)的外科手术室进行心房颤动(房颤)射频消融的安全性和有效性.方法 入组2021年1月至2022年6月在浙江大学医学院附属邵逸夫医院外科手术室接受房颤射频消融的患者,以患者年龄、性别、BMI为主要匹配特征,以1∶1配对的方式选取同时期行房颤消融的患者为导管室组做对照.最终149例手术室组及152例导管室组进入随访队列,观察患者房颤消融手术并发症以及1年房颤复发等临床终点.结果 两组间围手术期主要并发症发生率不存在明显差异,心包积液2.01％(3/149)比1.97％(3/152)(P=0.980);食道损伤0％(0/149)比0.66％(1/152)(P=0.321).术后1年成功率无差异,生存分析显示95.59％(130/136)比91.72％(122/133)(P=0.172).多因素Cox回归示手术室不是术后复发的独立危险因素(HR=0.32,P=0.054).同时手术室组术后发热及住院时间有优势,术后发热2.01％(3/149)比8.55％(13/152)(P=0.011);平均住院时间(3.3±1.2)d比(4.3±1.8)d(P=0.001),操作时间无差异(145.9±41.6)min比(154.6±45.1)min(P=0.139).结论 与传统导管室相比,在无DSA的外科手术室进行房颤射频消融,有效性、安全性和手术时间相当.
Objective To evaluate the safety and efficacy of radiofrequency ablation for atrial fibrillation in the surgical operating room without DSA(digital subtraction angiography).Methods Patients who underwent radiofrequency ablation for atrial fibrillation in the surgical operating room of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2021 to June 2022 were enrolled,and patients who underwent ablation for atrial fibrillation during the same period were selected as the Cath Lab group for control in a 1∶1 pair,using patient's age,gender,and BMI as the main matching characteristics.Finally,149 patients in the operating room group and 152 patients in the Cath Lab group were in cohort to observe clinical endpoints such as complications of AF ablation procedures and 1-year AF recurrence.Results There was no significant difference in the incidence of main perioperative complications between the two groups,including pericardial effusion 2.01％(3/149)vs.1.97％(3/152)(P=0.980);esophageal injury 0％(0/149)vs.0.66％(1/152)(P=0.321).There was no difference in the 1-year success rate between the two groups.Survival analysis showed 95.59％(130/136)vs.91.72％(122/133)(P=0.172).Multivariate Cox regression showed that operating room was not an independent risk factor for postoperative recurrence(HR=0.32,P=0.054).The operating room group had the advantages in postoperative fever and the length of hospital stay:postoperative fever 2.01％(3/149)vs.8.55％(13/152)(P=0.011);the mean hospital stay(3.3±1.2)days vs.(4.3±1.8)days(P=0.001),and the procedure time had no difference(145.9±41.6)min vs.(154.6±45.1)min(P=0.139).Conclusion Catheter ablation for atrial fibrillation in a DSA-free surgical operating room is comparable in effective-ness,safety,and procedure time when compared with a conventional Cath Lab.
方加圆;程晖;于路;蒋汝红;刘强;林建伟;孙雅逊;张培;蒋晨阳
浙江大学医学院,浙江杭州 310058浙江大学医学院附属邵逸夫医院心血管内科,浙江杭州 310016
临床医学
心房颤动;无射线射频消融;外科手术室;发热
atrial fibrillation;fluoroscopy-free radiofrequency ablation;surgical operating room;fever
《中国实用内科杂志》 2024 (003)
210-217 / 8
国家自然科学基金(81970269)
10.19538/j.nk2024030107
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