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目的分析本中心不同阶段心房颤动(房颤)导管消融并发症的发生率和演变特征。方法2004年10月至2008年12月共有2260例房颤患者在本中心接受导管消融,包括男性1265例,女性995例;阵发性房颤1449例,慢性房颤811例。消融术式为三维标测系统指引环肺静脉电隔离术,对于慢性房颤附加碎裂电位消融。分为三个时间段(2004—2006年、2007年、2008年)统计并发症发生和诊治情况。结果共发生并发症61例(占2.70%),其中心脏压塞11例,血栓栓塞18例,肺静脉狭窄14例,血管穿刺并发症18例。2004—2006年心脏压塞5例(2例外科修补),脑栓塞3例(1例肌力减退),肠系膜动脉栓塞1例,肺静脉狭窄6例,血管穿刺并发症6例;2007年心脏压塞4例(2例外科修补),脑栓塞3例(1例死亡、2例肌力减退),肠系膜动脉栓塞1例,肺静脉狭窄4例,血管穿刺并发症5例;2008年心脏压塞2例(内科保守),脑栓塞7例(5例肌力减退),肠系膜动脉栓塞3例,肺静脉狭窄4例,血管穿刺并发症7例(1例血胸、1例股动静脉瘘,外科修补)。三个阶段并发症发生率差异无统计学意义(2.6%比2.6%比2.8%,P=0.93),2008年心脏压塞发生率(0.2%)较2004—2006年阶段(0.6%)和2007年阶段(0.6%)下降,P=0.5;血栓栓塞并发症发生率(1.0%)高于2004—2006年阶段(0.5%)和2007年阶段(0.6%),P=0.2。肺静脉狭窄和血管穿刺并发症发生率亦无显著变化。结论房颤导管消融总体安全性较好,虽然经验增加,但主要并发症并没有减少。
Objective To analyze the incidence and evolution characteristics of catheter ablation complications in different stages of atrial fibrillation (AF) in our center. Methods A total of 2260 patients with atrial fibrillation underwent catheter ablation in our center from October 2004 to December 2008, including 1265 males and 995 females; 1449 cases of paroxysmal atrial fibrillation and 811 cases of chronic atrial fibrillation. The ablation procedure is guided by a three-dimensional mapping system for circumferential pulmonary vein isolation, with additional fragmentation potential ablation for chronic atrial fibrillation. Divided into three time periods (2004-2006, 2007, 2008) statistical complication and diagnosis and treatment. Results A total of 61 cases (2.70%) had complications, of which 11 were cardiac tamponade, 18 were thromboembolism, 14 were pulmonary venous stenosis and 18 were vascular puncture complications. Cardiac occlusion in 5 cases (2 cases of surgical repair) in 2004-2006, cerebral embolism in 3 cases (1 case of muscle weakness), mesenteric artery embolization in 1 case, pulmonary vein stenosis in 6 cases, vascular puncture complications in 6 cases; 2007 heart pressure 4 cases (2 cases of surgical repair), 3 cases of cerebral embolism (1 case died and 2 cases of muscle weakness), 1 case of mesenteric artery embolization, 4 cases of pulmonary vein stenosis, 5 cases of vascular puncture complications; (Conservative), cerebral embolism in 7 cases (5 cases of muscle weakness), mesenteric artery embolization in 3 cases, pulmonary vein stenosis in 4 cases, vascular puncture complications in 7 cases (1 case of hemothorax, 1 case of femoral venous fistula, surgical repair ). There was no significant difference in the incidence of complications between the three stages (2.6% vs. 2.6% vs. 2.8%, P = 0.93), the incidence of cardiac tamponade in 2008 (0.2%) compared with 2004-2006 (0.6%) and 2007 The incidence of thromboembolic complications (1.0%) was higher than that in 2004-2006 (0.5%) and 2007 (0.6%), P = 0.2. There was no significant change in the incidence of pulmonary vein stenosis and complication of vascular puncture. Conclusion The overall safety of atrial fibrillation catheter ablation is good, although the experience increases, but the main complications did not decrease.