Murakawa Yuji, Yamane Teiichi, Goya Masahiko, Inoue Koichi, Naito Shigeto, Kumagai Koichiro, Miyauchi Yasushi, Morita Norishige, Nogami Akihiko, Shoda Morio, Okumura Ken, Hirao Kenzo
Fourth Department of Internal Medicine, Teikyo University School of Medicine.
The Department of Cardiology, The Jikei University School of Medicine.
J Arrhythm. 2017 Oct;33(5):430-433. doi: 10.1016/j.joa.2017.04.009. Epub 2017 May 12.
Pericardial effusion (PE) is one of the most frequent complications from catheter ablation of atrial fibrillation (AF). We assessed the prevalence and predictive factors of PE that require invasive treatment as an early complication of AF ablation.
The Japanese Heart Rhythm Society requested electrophysiology centers to register the relevant data of patients who underwent AF ablation during 6 months from 2011 to 2015. We compared the clinical profiles and the procedures of AF ablation between patients who had ablation-related PE and those who did not.
Two-hundred-and-eight institutions reported the data of 8319 AF ablation sessions (age 63.4±10.7 years). A total of 414 complications occurred in 401 patients (4.8%). The incidence of invasively treated critical PE was 1.0% (n=85) of total procedures, while conservatively treated noncritical PE appeared in 95 subjects. When clinical and procedural variables were compared between patients who suffered critical PE and 8140 PE-free patients, deep sedation (p=0.030), impaired left ventricular function (p=0.031), and periprocedural warfarin (p=0.023) significantly increased the incidence of critical PE in univariate analysis. Use of 3-D imaging system (p<0.001) and a periprocedural direct oral anticoagulant (DOAC, p=0.002) were related with lower incidence of critical PE. Among these factors, multivariate logistic regression analysis showed that 3-D imaging system (odds ratio 0.23 [95% CI: 0.14-0.39], p<0.001) and a periprocedural DOAC (odds ratio 0.49 [95% CI: 0.27-0.90], p=0.020) are independent predictors of the lower incidence of PE.
Critical PE occurred in 1% of AF ablation procedures in Japan. Our results suggest that 3-D imaging system use independently reduces the frequency of PE. DOACs in the setting of catheter ablation of AF seemed to be non-inferior to warfarin in terms of safety and effectiveness.
心包积液（PE）是心房颤动（AF）导管消融最常见的并发症之一。我们评估了作为AF消融早期并发症需要侵入性治疗的PE的患病率及预测因素。
日本心律协会要求电生理中心登记2011年至2015年6个月期间接受AF消融患者的相关数据。我们比较了发生消融相关PE的患者与未发生者的临床特征及AF消融手术情况。
208家机构报告了8319例AF消融手术的数据（年龄63.4±10.7岁）。401例患者共发生414例并发症（4.8%）。侵入性治疗的严重PE发生率为全部手术的1.0%（n = 85），而95例患者出现保守治疗的非严重PE。当比较发生严重PE的患者与8140例无PE患者的临床及手术变量时，深度镇静（p = 0.030）、左心室功能受损（p = 0.031）及围手术期使用华法林（p = 0.023）在单因素分析中显著增加严重PE的发生率。使用三维成像系统（p < 0.001）及围手术期使用直接口服抗凝剂（DOAC，p = 0.002）与严重PE发生率较低相关。在这些因素中，多因素logistic回归分析显示三维成像系统（比值比0.23 [95% CI：0.14 - 0.39]，p < 0.001）及围手术期使用DOAC（比值比0.49 [95% CI：0.27 - 0.90]，p = 0.020）是PE发生率较低的独立预测因素。
在日本，1%的AF消融手术发生严重PE。我们的结果表明，使用三维成像系统可独立降低PE的发生率。在AF导管消融中，DOAC在安全性和有效性方面似乎不劣于华法林。
