我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

较低活化凝血时间下心房颤动消融术并发症的发生率及出血并发症的危险因素

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第1期
页码:
60-064
栏目:
临床研究
出版日期:
2016-10-05

文章信息/Info

Title:
Complication rate and risk factors for bleeding during atrial fibrillation ablation under lower activated clotting times
作者:
张 波; 凌智瑜; 苏 立; 杜华安; 肖培林; 刘增长; 殷跃辉
（重庆医科大学附属第二医院心内科、重庆市心律失常治疗中心，重庆 400010）
Author(s):
ZHANG Bo;  LING Zhi-yu;  SU Li;  DU Hua-an;  XIAO Pei-lin;  LIU Zeng-zhang;  YIN Yue-hui
(Cardiovascular Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China)
关键词:
心房颤动; 活化凝血时间; 消融术; 并发症; 危险因素
Keywords:
atrial fibrillation;  activated clotting time;  ablation;  complication;  risk factor
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的 观察和分析较低活化凝血时间（ACT）条件下心房颤动（房颤）消融术的安全性及其主要并发症的危险因素。方法 收集并整理于我院行射频或冷冻球囊消融术的231例房颤患者的临床资料。按消融术中所测ACT的平均值（以下简称ACT）分为<200 s，200~<250 s和≥250 s3组，计算并比较各组栓塞及出血并发症的发生率，再按是否发生出血并发症分为出血并发症组和未出血并发症组，按病例对照研究进行单因素分析和多因素logistic回归分析，分析出血并发症的危险因素。结果 全部患者发生并发症13例，总发生率为5.6%，<200s，200~<250 s和≥250 s3组的总发生率分别为4%、3%和13%，≥250组总发生率显著高于200~<250 s组（P<0.05）。≥250 s组出血并发症发生率显著高于200~<250 s组（11% vs. 1%，P<0.01），3组其他并发症无显著差异。多因素logistic回归分析结果提示手术耗时(P<0.01,OR=1.025,95%CI:1.007~1.043)、公斤体质量肝素注射量(P<0.01,OR=1.067,95%CI:1.020~1.116)及术中ACT(P<0.01，OR=1.065,95%CI:1.017~1.114)是出血并发症的独立危险因素。结论 对CHADS2评分<2分的房颤患者，将消融术中ACT维持在200~<250 s是相对安全的。手术耗时、公斤体质量肝素注射量及术中ACT是发生出血并发症的独立危险因素。
Abstract:
AIM To observe and analyze the risk factors for major complications and the safety of atrial fibrillation (AF) ablation under lower activated clotting times (ACTs). METHODSClinical data of 231 AF patients who underwent radiofrequency or cryoballoon ablation were collected. According to the value of averaged ACT during ablation procedure, patients were divided into three groups: average ACT <200 s, 200-250 s and ≥250 s. Embolic and bleeding complication rates of each group were analyzed. Patients were then categorized into bleeding group and non-bleeding group according to the occurrence of bleeding complications. In this case-control study, uni- and multivariate logistic regression analysis were performed to identify the predictors of bleeding complications. RESULTSComplications occurred in 13 (5.6%) patients. The total complication rates in groups of <200 s, 200-250 s and ≥250 s were 4%,3% and 13%, respectively, which was much higher in the >250 s group than in the 200-250 s group (P<0.05). Compared with the 200-250 s group, bleeding complication rate of ≥250 s group was much higher (11%:1%, P<0.01). Differences in other complications among the three groups were not significant. Multivariate logistic regression analysis indicated that the total procedural time (P<0.01, OR=1.025, 95%CI: 1.007-1.043), heparin bolus normalized for body weight (P<0.01, OR=1.067, 95%CI: 1.020-1.116) and averaged ACT (P<0.01, OR=1.065, 95%CI: 1.017-1.114) during ablation procedure were independent risk factors for bleeding complications. CONCLUSIONAF ablation is relatively safe with a target ACT of 200-250 s for patients with CHADS2 scores<2. Furthermore, total procedural time, heparin bolus normalized for body weight and average ACT during ablation procedure prove to be independent predictors of bleeding complications.

参考文献/References

[1]Calkins H,Reynolds MR,Spector P,et al.Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation:two systematic literature reviews and meta-analyses[J].Circ Arrhythm Electrophysiol,2009,2(4):349-361.
[2]Andrade JG,Khairy P,Guerra PG,et al.Efficacy and safety of cryoballoon ablation for atrial fibrillation:a systematic review of published studies[J].Heart Rhythm,2011,8(9):1444-1451.
[3]Calkins H,Kuck KH,Cappato R,et al.2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation:Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions,Endpoints, and Research Trial Design[J].Heart Rhythm,2012,9(4):632-696.
[4]黄从新，张 澍，马长生,等.心房颤动治疗:目前的认识和建议2012[J].《中华心律失常学杂志》,2012,16(6):404-406.
[5]Houmsse M,Daoud EG.Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation[J].Expert Rev Med Devices,2012,9(1):59-70.
[6]Avitall B,Kalinski A.Cryotherapy of cardiac arrhythmia:From basic science to the bedside[J].Heart Rhythm,2015,12(10):2195-2203.
[7]Hoyt H,Bhonsale A,Chilukuri K,et al.Complications arising from catheter ablation of atrial fibrillation:temporal trends and predictors[J].Heart Rhythym,2011,8(12):1869-1874.
[8]汤日波，马长生，董建增，等.CHADS2评分对心房颤动导管消融并发症的预测价值[J].临床心血管病杂志,2014,30(8):699-702.
[9]Di Biase L,Burkhardt JD,Mohanty P,et al.Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation:the impact of periprocedural therapeutic international normalized ratio[J].Circulation,2010,121(23):2550-2556.
[10]Maleki K,Mohammadi R,Hart D,et al.Intracardiac ultrasound detection of thrombus on transseptal sheath:incidence,treatment,and prevention[J].J Cardiovasc Electrophysiol,2005,1 6(6):561-565.
[11]Ren JF, Marchlinski FE,Callans DJ,et al.Increased intensity of anticoagulation may reduce risk of thrombus during atrial fibrillation ablation procedures in patients with spontaneous echo contrast［J］. J Cardiovasc Electrophysiol, 2005, 16(5):474-477.
[12]Nakagawa H,Yamanashi WS,Pitha JV,et al.Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation[J].Circulation,1995,91(8):2264-2273.
[13]Nakagawa H,Wittkampf FH,Yamanashi WS,et al.inverse relationship between electrode size and lesion size during radiofrequency ablation with active electrode cooling[J].Circulation,1998,98(5):458-465.
[14]Winkle RA,Mead RH,Engel G,et al.Safety of lower activated clotting times during atrial fibrillation ablation using open irrigated tip catheters and a single transseptal puncture[J].Am J Cardiol,2011,107(5):704-708.
[15]Winkle RA,Mead RH,Engel G,et al.Atrial fibrillation ablation using open-irrigated tip radiofrequency:experience with intraprocedural activated clotting times ≤210 seconds[J].Heart Rhythm,2014,11(6):963-968.
[16]Mugnai G,Irfan G,de Asmundis C,et al.Complications in the setting of percutaneous atrial fibrillation ablation using radiofrequency and cryoballoon techniques:A single-center study in a large cohort of patients[J].Int J Cardiol,2015,196:42-49.
[17]Cappato R,Calkins H,Chen SA,et al.Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation[J].Circ Arrhythm Electrophysiol,2010,3(1):32-38.

备注/Memo

备注/Memo:
收稿日期：2016-01-02.
通讯作者：殷跃辉，主任医师，主要从事心律失常的临床与基础研究 Email：yinyh63@163.com
作者简介：张波，医师，硕士生 Email：13648403273@163.com
更新日期/Last Update: 2016-10-09