Tang Ri Bo, Dong Jian Zeng, Liu Xing Peng, Fang Dong Ping, Long De Yong, Liu Xiao Hui, Yu Rong Hui, Hu Fu Li, Lu Chun Shan, Hao Peng, Kalifa Jérôme, Ma Chang Sheng
Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing, China.
J Interv Card Electrophysiol. 2006 Oct;17(1):41-6. doi: 10.1007/s10840-006-9049-x. Epub 2007 Jan 18.
Little is known about the outcome of catheter ablation of atrial fibrillation (AF) in patients with diabetes mellitus (DM). We investigated the safety and efficacy of catheter ablation of AF in patients with DM.
Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure were enrolled in a prospective study. The ablation protocol (guided by CARTO system) consisted in two continuous circular lesions around ipsilateral pulmonary veins.
The following clinical characteristics differed between DM and no-DM patients: age (62.0 +/- 10.8 vs. 56.1 +/- 10.6 years, P = 0.004), longer AF history (9.6 +/- 9.3 vs. 6.7 +/- 6.3 years, P = 0.024), significantly larger left atrium size (41.1 +/- 7.8 vs. 38.3 +/- 5.8 mm, P = 0.021), hypertension (58.1 vs. 35.8%, P = 0.018) and structural heart disease (67.7 vs. 43.5%, P = 0.011). Despite a similar AF recurrence rate in DM and no-DM patients (32.3 vs. 22.4%, P = 0.240), the ablation procedure was complicated in 28 patients (11 hematomas, three cardiac tamponades and three strokes) and the incidence of complications was significantly higher in DM than in no-DM patients (29.0 vs. 8.2%, respectively, P = 0.002). Multivariate analysis showed that DM was an independent risk factor for complications occurrence (odd ratio 5.936, 95% confidence interval 2.059 to 17.112, P = 0.001).
First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients. However, DM patients had a higher incidence of complications, mostly thrombotic or hemorrhagic.
关于糖尿病（DM）患者房颤（AF）导管消融的结果知之甚少。我们研究了DM患者AF导管消融的安全性和有效性。
在一组263例首次接受AF导管消融术的连续患者中，纳入31例DM患者进行前瞻性研究。消融方案（由CARTO系统引导）包括围绕同侧肺静脉的两个连续圆形损伤。
DM患者与非DM患者的以下临床特征存在差异：年龄（62.0±10.8岁对56.1±10.6岁，P = 0.004），房颤病史更长（9.6±9.3年对6.7±6.3年，P = 0.024），左心房大小明显更大（41.1±7.8对38.3±5.8mm，P = 0.021），高血压（58.1%对35.8%，P = 0.018）和结构性心脏病（67.7%对43.5%，P = 0.011）。尽管DM患者和非DM患者的房颤复发率相似（32.3%对22.4%，P = 0.240），但28例患者的消融手术出现并发症（11例血肿、3例心脏压塞和3例中风），DM患者的并发症发生率显著高于非DM患者（分别为29.0%和8.2%，P = 0.002）。多变量分析表明，DM是并发症发生的独立危险因素（比值比5.936，95%置信区间2.059至17.112，P = 0.001）。
DM患者首次AF导管消融术的疗效与非DM患者相当。然而，DM患者的并发症发生率更高，主要是血栓形成或出血性并发症。
