导管消融术和围手术期抗凝方案对伴有或不伴有预先存在偏头痛的心房颤动患者偏头痛临床过程的影响：前瞻性研究的结果。
Effect of catheter ablation and periprocedural anticoagulation regimen on the clinical course of migraine in atrial fibrillation patients with or without pre-existent migraine: results from a prospective study.
机构信息
From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
出版信息
Circ Arrhythm Electrophysiol. 2015 Apr;8(2):279-87. doi: 10.1161/CIRCEP.114.002285. Epub 2015 Feb 14.
BACKGROUND
We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history.
METHODS AND RESULTS
Forty patients with (group 1: 64 ± 8 years; men 78%) and 85 (group 2: 61 ± 10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires. Diffusion magnetic resonance imaging of brain was performed for all at pre and 24 hours post procedure. Catheter ablation was performed with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from groups 1 and 2, respectively) had subtherapeutic international normalized ratio on procedure day. At 17 ± 5 months follow-up, from group 1, 25 (63%) reported no migraine, 10 (25%) had < 1, and 3 (8%) had 2 to 3 monthly symptoms. Intensity of pain decreased from baseline 7 (Q1-Q3, 4-8) to 2 (0-4) scale points at follow-up (P < 0.001) and duration of headache from median 8 (Q1-Q3, 4-15) to 0.5 (Q1-Q3, 0-2) hours (P < 0.001). Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. Follow-up diffusion magnetic resonance imaging revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural international normalized ratio on or off continuous warfarin. Quality of life improved significantly in patients with successful ablation, being more pronounced in group 1.
CONCLUSIONS
In most patients, migraine symptoms improved substantially after catheter ablation. Interestingly, the only cases of new migraine and aggravation of pre-existent headache had subtherapeutic international normalized ratio during the procedure and new cerebral infarcts.
背景
我们研究了导管消融和围手术期抗凝方案对伴有或不伴有偏头痛病史的心房颤动患者偏头痛轨迹的影响。
方法和结果
共纳入 40 例（组 1：64±8 岁；男性 78%）和 85 例（组 2：61±10 岁；男性 73%）有或无偏头痛病史的心房颤动消融患者。采用标准化问卷评估偏头痛状态和生活质量。所有患者在术前和术后 24 小时进行脑弥散磁共振成像。导管消融在（88，70%）或不（37，30%）连续使用华法林的情况下进行。54 例患者（分别来自组 1 和组 2 的 11 例和 43 例）在手术当天的国际标准化比值低于治疗范围。在 17±5 个月的随访中，组 1 中 25 例（63%）报告无偏头痛，10 例（25%）有＜1 次偏头痛/月，3 例（8%）有 2-3 次偏头痛/月。疼痛强度从基线的 7（Q1-Q3，4-8）下降到随访时的 2（0-4）分（P＜0.001），头痛持续时间从中位数 8（Q1-Q3，4-15）下降到 0.5（Q1-Q3，0-2）小时（P＜0.001）。组 1 中有 2 例患者报告偏头痛严重程度增加，组 2 中有 2 例患者新发偏头痛。随访弥散磁共振成像显示 125 例患者中有 9.6%（12/125）出现新的梗死灶；其中 11 例在术前有低于治疗范围的国际标准化比值，无论是否持续使用华法林。在消融成功的患者中，生活质量显著改善，组 1 更为明显。
结论
在大多数患者中，导管消融后偏头痛症状明显改善。有趣的是，新出现偏头痛和原有头痛加重的仅有的病例在手术过程中出现了低于治疗范围的国际标准化比值，并且出现了新的脑梗死。
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