Xu J J, Gao L J, Chang D, Xiao X J, Zhang R F, Lin J, Zhao Z M, Zhang H, Xia Y L, Yin X M, Yang Y Z
First Affiliated Hospital of Dalian Medical University, Dalian 116000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Nov 24;45(11):935-939. doi: 10.3760/cma.j.issn.0253-3758.2017.11.008.
To compare the outcome of radiofrequency catheter ablation under local anesthesia/sedation (S) or general anesthesia(GA) in atrial fibrillation patients. Data of 498 patients with atrial fibrillation undergoing radiofrequency catheter ablation in our departmentfrom January 2014 to December 2015 were retrospectively analyzed. Two hundred and twenty patients assigned to the GA group, the other 278 patients to the S group. Patients were followed clinically every 3 months within one year after procedure. Immediate electrocardiogram was performed in patients with palpitation or choking sensation in chest. The end point of the study was recurrence of any atrial tachyarrhythmia lasting >30 seconds in device interrogation, 24-hour Holter monitoring or 12-lead electrocardiogram after a single procedure. After the ablation procedure, a blanking period of 3 months was allowed according to the guidelines. Procedure time, radiofrequency time, fluoroscopy time, the detection of paroxysmal supraventricular tachycardia, the success rate and the complications were compared between the two groups. There was no difference in the baseline characteristics between the two groups, such as age, gender, BMI, complications, LVEF, LAD (all >0.05). The duration of procedure ((117.8±51.7)minutes vs.(115.4±36.9)minutes, =0.79), duration of fluoroscopy((12.5±11.2)minutes vs. (10.4±10.2)minutes, =0.35), duration of radiofrequency((40.1±12.9)minutes vs. (48.6±44.3)minutes, =0.48) were similar between the two groups (>0.05). Compared with S group, discovery of the frequency of atrioventricular node reentrant tachycardia (AVNRT) was significantly lower in GA group (0 vs. 3.6%(10/278), <0.01), but the difference disappeared with repeat electrophysiological examination when patients become conscious from GA(3.2%(7/220) vs. 3.6%(10/278), =0.311). The difference of atrioventricular reentrant tachycardia (AVRT) was similar between the two groups(0.9%(2/220) vs. 0.7%(2/278), =0.841). Compared with S group, reflection of vagus nerve was less in GA group (1.4%(3/220) vs. 8.6%(24/278), =0.026). After following up of (356±92) days, freedom from atrial fibrillation/atrial flutter/atrial tachyarrhythmia was similar between the two groups(77.9%(162/208) vs. 79.9%(215/269), =0.818). General anesthesia is a promising method to atrial fibrillation ablation, in view of stable patient status and safety for the procedure. There is no difference in complications, recurrence of arrhythmia between the two groups, but detection rate of AVNRT is lower in GA group.
比较局部麻醉/镇静(S)或全身麻醉(GA)下房颤患者射频导管消融的结果。回顾性分析2014年1月至2015年12月在我科接受射频导管消融的498例房颤患者的数据。220例患者分配至GA组,另外278例患者分配至S组。术后1年内每3个月对患者进行临床随访。有心悸或胸部憋闷感的患者进行即刻心电图检查。研究终点为单次手术后通过设备问询、24小时动态心电图监测或12导联心电图检测到持续>30秒的任何房性快速心律失常复发。根据指南,消融术后允许3个月的空白期。比较两组的手术时间、射频时间、透视时间、阵发性室上性心动过速检出率、成功率及并发症。两组患者的基线特征如年龄、性别、BMI、并发症、左室射血分数、左房内径等无差异(均>0.05)。两组的手术持续时间((117.8±51.7)分钟 vs.(115.4±36.9)分钟,P =0.79)、透视持续时间((12.5±11.2)分钟 vs.(10.4±10.2)分钟,P =0.35)、射频持续时间((40.1±12.9)分钟 vs.(48.6±44.3)分钟,P =0.48)相似(均>0.05)。与S组相比,GA组房室结折返性心动过速(AVNRT)的检出率显著更低(0 vs. 3.6%(10/278),P<0.01),但当患者从GA麻醉中清醒后重复电生理检查时差异消失(3.2%(7/220) vs. 3.6%(10/278),P =0.311)。两组间房室折返性心动过速(AVRT)的差异相似(0.9%(2/220) vs.0.7%(2/278),P =0.841)。与S组相比,GA组迷走神经反射更少(1.4%(3/220) vs. 8.6%(24/278),P =0.026)随访(356±92)天后,两组无房颤/房扑/房性快速心律失常的比例相似(77.9%(162/208) vs. 79.9%(215/269),P =0.818)。鉴于患者状态稳定且手术安全,全身麻醉是一种有前景的房颤消融方法。两组间并发症、心律失常复发无差异,但GA组AVNRT的检出率更低。