Hu Z C, Jiang C, Liu S Y, Zhang Z M, Zhang S, Fan S Y, Zheng L H, Ma C S, Yao Yan
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Mar 24;49(3):224-228. doi: 10.3760/cma.j.cn112148-20201123-00929.
To define the current status and analyze the medical quality of interventional therapy for patients with atrial fibrillation (AF) in China. This survey was performed in all seven large regions of China, one to three regional major medical centers were selected from each region. Medical records of patients underwent interventional therapy for AF in the year 2017 were randomly inspected. CHADS-VASc score, prescribed anticoagulant after ablation, indication of left atrial appendage occlusion (LAAO), and complications in the medical records were analyzed. A total of 10 800 AF catheter ablations and 447 LAAOs were performed in 17 regional medical centers in 2017. There were 10/17 centers performing AF catheter ablation<500 cases and 7/17 centers performing LAAO<20 cases. A total of 1 347 cases of catheter ablation and 160 cases of LAAO were selected for further analysis. Among all selected cases, 15.8% (238/1 505) non-valvar AF cases recorded CHADS-VASc scores. The anticoagulation rate after AF catheter ablation was 98.6% (1 328/1 347), anticoagulation rate was higher than 90% in 16 out of 17 centers. The complication and severe complication rates of AF catheter ablation were 0.9% (12/1 347) and 0.4% (5/1 347), respectively. The differences of complication and severe complication rates in AF catheter ablation were similar between centers performing<500 cases and centers performing ≥500 cases (0.5% (2/413) vs. 1.1% (10/934), >0.05; 0.5% (2/413) vs. 0.3% (3/934), >0.05). The coincidence rate of LAAO indication was 81.3% (130/160), and the rate was higher in center performing ≥20 cases than in centers performing<20 cases (84.8% (106/125) vs. 68.6% (24/35), <0.05). The complication and severe complication rates of LAAO were 3.1% (5/160) and 1.9% (3/160). The rate of complications in LAAO was higher in center performing<20 cases than in centers performing ≥20 cases (8.6% (3/35) vs. 1.6% (2/125), <0.05), and there was no significant difference in severe complication rate (5.7% (2/35) vs. 0.8% (1/125), >0.05). Interventional therapy for AF in China is generally standardized and safe. The overall incidence of complications post AF interventional ablation is low, the anticoagulation rate after AF catheter ablation is high, and the adherence rate of LAAO indication is fair. The indicators mentioned above vary widely among centers.
明确中国心房颤动（AF）患者介入治疗的现状并分析其医疗质量。本调查在中国所有七个大区进行，每个大区选取一至三个区域主要医疗中心。随机抽检2017年接受AF介入治疗患者的病历。分析病历中的CHADS-VASc评分、消融术后开具的抗凝药、左心耳封堵术（LAAO）的适应证及并发症。2017年17个区域医疗中心共进行了10800例AF导管消融术和447例LAAO。17个中心中有10个进行AF导管消融术的病例数<500例，7个进行LAAO的病例数<20例。共选取1347例导管消融病例和160例LAAO病例进行进一步分析。在所有入选病例中，15.8%（238/1505）非瓣膜性AF病例记录了CHADS-VASc评分。AF导管消融术后的抗凝率为98.6%（1328/1347），17个中心中有16个中心的抗凝率高于90%。AF导管消融术的并发症和严重并发症发生率分别为0.9%（12/1347）和0.4%（5/1347）。进行<500例手术的中心与进行≥500例手术的中心在AF导管消融术的并发症和严重并发症发生率上的差异相似（0.5%（2/413）对1.1%（10/934），>0.05；0.5%（2/413）对0.3%（3/934），>0.05）。LAAO适应证的符合率为81.3%（130/160），进行≥20例手术的中心的该率高于进行<20例手术的中心（84.8%（106/125）对68.6%（24/35），<0.05）。LAAO的并发症和严重并发症发生率分别为3.1%（5/160）和1.9%（3/160）。进行<20例手术的中心的LAAO并发症发生率高于进行≥20例手术的中心（8.6%（3/35）对1.6%（2/125），<0.05），严重并发症发生率无显著差异（5.7%（2/35）对0.8%（1/125），>0.05）。中国AF的介入治疗总体规范且安全。AF介入消融术后并发症的总体发生率较低，AF导管消融术后抗凝率较高，LAAO适应证的依从率尚可。上述指标在各中心之间差异较大。
