Cardiology Division, Hillel Yaffe Medical Center, Hadera, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Cardiovasc Electrophysiol. 2022 Jun;33(6):1128-1135. doi: 10.1111/jce.15459. Epub 2022 Apr 5.
Catheter ablation (CA) for atrial fibrillation (AF) is increasingly utilized in recent years, with promising results. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for AF in patients with mechanical prosthetic valves (MPVs).
We drew data from the US National Inpatient Sample (NIS) database to identify cases of AF ablations in patients with MPVs, between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of procedural complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity-matched cohort of patients without MPVs. The study included a weighted total of 1898 CA for AF cases in patients with MPVs. The median age of the study population was 67 (61-75) years and 53% were males. Despite the increasing age and significant uptrend in the prevalence of individual comorbidities and Deyo-Charlson Comorbidity Index (CCI) over the years, the risk of peri-procedural complications and mortality in the study group did not change between the early (2003-2008) and late (2009-2015) study years. The peri-procedural complication rate (8.4% vs. 10.4%, p = .33) and in-hospital mortality (0.2% vs. 0.2%, p = .9) did not differ significantly between patients with MPVs and 1901 matched patients without MPVs. Length of stay was higher among patients with prior MPVs compared to the controls (4.0 ± 0.2 vs. 3.3 ± 0.2 days, p = .011).
This nationwide analysis shows that AF ablation in patients with mechanical valve prothesis bares a similar risk of periprocedural complications and mortality as in patients without prosthetic valves.
近年来，导管消融（CA）治疗心房颤动（AF）的应用越来越多，效果也很有前景。我们旨在研究机械人工心脏瓣膜（MPV）患者中 CA 治疗 AF 的全国范围内的应用趋势和程序并发症。
我们从美国国家住院患者样本（NIS）数据库中提取数据，以确定 2003 年至 2015 年间患有 MVP 的 AF 消融病例。收集了人口统计学和临床数据，并分析了程序并发症、死亡率和住院时间的发生率。我们将结果与无 MVP 的患者的倾向匹配队列进行比较。该研究包括了 1898 例 MVP 患者的 CA 治疗 AF 病例。研究人群的中位年龄为 67（61-75）岁，其中 53%为男性。尽管年龄不断增加，且个体合并症和 Deyo-Charlson 合并症指数（CCI）的患病率呈显著上升趋势，但研究组在研究早期（2003-2008 年）和晚期（2009-2015 年）之间，围手术期并发症和死亡率并没有变化。研究组的围手术期并发症发生率（8.4% vs. 10.4%，p = 0.33）和院内死亡率（0.2% vs. 0.2%，p = 0.9）与 1901 例无 MVP 的匹配患者相比没有显著差异。与对照组相比，先前有 MVP 的患者的住院时间更长（4.0±0.2 天 vs. 3.3±0.2 天，p = 0.011）。
这项全国性分析表明，机械瓣置换患者的 AF 消融术具有与无人工瓣膜患者相似的围手术期并发症和死亡率风险。
