摘要
目的描述单中心心房颤动（房颤）射频消融术后患者长期抗凝治疗的现状,探讨决定抗凝治疗策略的影响因素。方法选取2012年1月至2015年8月就诊于北京大学第一医院因房颤行射频消融治疗并于门诊随访的患者144例,收集并描述患者手术前基线资料、随访期间口服抗凝药物（OAC）使用情况及血栓栓塞和大出血事件的发生情况。根据射频消融3个月后是否中断抗凝治疗将患者分为两组,采用二元logistic回归分析射频消融术后患者长期抗凝治疗决策的影响因素。结果 144例房颤患者共行158次射频消融术,中位随访时间为17.5（12.0,29.8）个月。根据基线CHA2DS2-VASc评分,血栓栓塞高危患者共92例（63.9%）。1次射频消融术后12个月内房颤复发共53例（36.8%）。随访过程中,共140例（97.2%）患者按计划抗凝治疗至术后3个月,4例（2.8%）患者提前终止抗凝治疗。按计划抗凝治疗至术后3个月的140例患者中,CHADS2≥2分的46例患者中有17例（37.0%）、CHA2DS2-VASc≥2分的89例患者中有32例（36.0%）患者持续OAC;射频消融3个月后,共104例（74.3%）患者中断OAC,其中34例（32.7%）术后12个月内房颤复发,复发患者中有17例重新开始OAC。多因素二元logistic回归分析显示,术后12个月内房颤复发是影响是否持续抗凝的独立危险因素（OR 2.88,95%CI 1.22～6.79,P=0.016）。在校正了CHA2DS2-VASc评分后发现,术后12个月内房颤复发仍是影响是否持续抗凝的独立危险因素（OR 2.88,95%CI 1.21～6.81,P=0.016）。血栓栓塞事件共发生4例（2.8%）,均发生于停用OAC后,根据术前血栓栓塞评分,4例患者CHA2DS2-VASc≥2分,仅2例患者CHADS2≥2分;其中3例患者术后12个月内无房颤复发。大出血事件共发生2例（1.4%）,均发生于持续服用OAC过程中。结论射频消融术后12个月内房颤复发是除CHA2DS2-VASc外决定患者长期抗凝治疗的主要因素。
Objective To describe the long-term condition of oral anticoagulation（ OAC） therapy after radiofrequency ablation（ RFA） of atrial fibrillation（ AF）,identify factors that have impact on decision of continuation of OAC therapy. Methods 144 patients diagnosed with atrial fibrillation underwent RFA in our department from January,2012 to August,2015 were enrolled in the study. Patient data were collected and risk profiles were evaluated by CHADS2 and CHA2DS2-VASc score. The long-term condition of OAC therapy after RFA of AF and risk factors of OAC strategy were analyzed by statistical methods including univariate and multivariate logistic regression. Results The study included 144 patients who underwent 158 RFA procedures of AF. According to the CHA2DS2-VASc score,92（ 63. 9%） high-risk cases were identified. 53（ 36. 8%） patients experienced recurrence of AF within 1 year after single RFA procedure.During a median follow-up of 17. 5 months（ IQR： 12. 0- 29. 8）,140（ 97. 2%） cases continued OAC beyond 3 months after RFA while 4（ 2. 8%） cases stopped within 3 months after RFA. For those who continued OAC therapy beyond 3 months,17（ 37. 0%） cases with a CHADS2 ≥2 and 32（ 36. 0%） with a CHA2DS2-VASc≥2 continued OAC therapy till the end of follow-up or the study end point. 104（ 74. 3%）patients discontinued OAC therapy during the follow-up,among them 34（ 32. 7%） experienced recurrence of AF within 1 year after RFA and only 17 restarted OAC therapy after the recurrence was identified. OAC continuation was significantly associated with recurrence of AF within 1 year after RFA [OR = 2. 88（ 1. 22-6. 79）,P = 0. 016] in multivariate analysis,even after adjustment with CHA2DS2-VASc score [OR = 2. 88（ 1. 21- 6. 81）,P = 0. 016]. 4（ 2. 8%） patients who discontinued OAC therapy experienced embolization events. All of them had a CHA2DS2-VASc≥2 while only 2 had a CHADS2≥2,and recurrence of AF within 1 year after RFA were seen in only 1 patient. 2（ 1. 4%） patients who continued OAC therapy experienced major bleeding events. Conclusions In patients post RFA of AF,long term OAC therapy was prescribed based on the status of of AF recurrence within 1 year besides the CHA2DS2-VASc score.
出处
《中国介入心脏病学杂志》
2016年第5期241-246,共6页
Chinese Journal of Interventional Cardiology
关键词
心房颤动
射频消融
危险分层
血栓栓塞
大出血
口服抗凝
Atrial fibrillation
Radio frequency ablation
Risk stratification
Thromboembolism
Major bleeding
Oral anticoagulation
