Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
Arrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
J Interv Card Electrophysiol. 2021 Apr;60(3):419-426. doi: 10.1007/s10840-020-00745-7. Epub 2020 May 6.
In patients with cancer, the safety of catheter ablation for non-valvular atrial fibrillation (AF) has not been evaluated, yet. The aim of this study was to assess the safety of AF ablation in cancer survivors.
Consecutively recruited patients undergoing catheter ablation of non-valvular AF at our center between March 2015 and March 2017 were evaluated. The primary outcome of the study was clinically relevant bleedings occurred within 30 ± 5 days after the procedure. Patients with cancer were propensity matched to patients without cancer in a 1:3 and 1:6 ratio after stratification by baseline clinical features.
Overall, 184 patients were included in the study. Of them, 21 (11%) were cancer survivors. Cancer site was more frequently gastrointestinal (36%), breast (23%), and genitourinary (18%). At 30 ± 5 days, clinically relevant bleedings occurred in 14 patients. Crude odds ratio (OR) for clinically relevant bleedings was 3.60 (95% CI 1.02-12.7) higher in cancer than in non-cancer patients. This trend remained after propensity score-matched population (OR 3.48, 95% CI 0.76-15.90 for matched 1:3, OR 4.95, 95% CI 1.2-20.2 for matched 1:6). Type of anticoagulation was not associated with bleedings.
Preliminary results suggest that clinically relevant bleeding after catheter ablation for AF is more frequent in cancer survivors than in patients without cancer. Further studies are required to confirm the present data.
在癌症患者中，尚未评估导管消融治疗非瓣膜性心房颤动（AF）的安全性。本研究旨在评估癌症幸存者行 AF 消融的安全性。
评估 2015 年 3 月至 2017 年 3 月期间在我院行非瓣膜性 AF 导管消融术的连续入组患者。该研究的主要结局为术后 30±5 天内发生的临床相关出血。将癌症患者与无癌症患者按照基线临床特征进行分层，按 1:3 和 1:6 的比例进行倾向评分匹配。
共有 184 例患者纳入研究。其中，21 例（11%）为癌症幸存者。癌症部位更常见于胃肠道（36%）、乳腺（23%）和泌尿生殖系统（18%）。术后 30±5 天，14 例患者发生临床相关出血。癌症患者发生临床相关出血的粗比值比（OR）为非癌症患者的 3.60（95%CI 1.02-12.7）。在倾向评分匹配人群中，这种趋势仍然存在（匹配 1:3 的 OR 为 3.48，95%CI 0.76-15.90；匹配 1:6 的 OR 为 4.95，95%CI 1.2-20.2）。抗凝类型与出血无关。
初步结果表明，癌症幸存者行 AF 导管消融术后发生临床相关出血的频率高于无癌症患者。需要进一步研究来证实目前的数据。
