房室旁道的门诊射频导管消融术的安全性、可行性及成本

Safety, feasibility and cost of outpatient radiofrequency catheter ablation of accessory atrioventricular connections.

作者信息

Kalbfleisch S J, el-Atassi R, Calkins H, Langberg J J, Morady F

机构信息

Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.

出版信息

J Am Coll Cardiol. 1993 Mar 1;21(3):567-70. doi: 10.1016/0735-1097(93)90086-g.

DOI:10.1016/0735-1097(93)90086-g

PMID:8436736

Abstract

OBJECTIVES

The purpose of this study was to evaluate prospectively the safety, feasibility and cost of performing radiofrequency catheter ablation of accessory atrioventricular (AV) connections on an outpatient basis in 137 cases.

BACKGROUND

The efficacy and low complication rate of radiofrequency ablation as performed in the hospital suggested that it might be feasible to perform it on an outpatient basis.

METHODS

In 100 cases (73%) performed between September 1, 1991 and April 20, 1992, patients met criteria for treatment as outpatients. Reasons for exclusion were age < 13 or > 70 years (4), anteroseptal location of the accessory AV connection (5 patients), obesity (> 30% of ideal body weight) (4 patients) or clinical indication for hospitalization (24 patients). Patients with only venous punctures had a recovery period of 3 h and those with arterial punctures had a recovery period of 6 h. There were 63 men and 32 women (5 patients underwent two ablation procedures > 1 month apart), with a mean age +/- SD of 36 +/- 13 years. The pathway was left-sided in 67 cases and right-sided or posteroseptal in 33.

RESULTS

The procedure was successful in 97 of 100 cases, with a mean procedure duration of 99 +/- 42 min. In 70 cases the patient was discharged the day of ablation, and in 30 cases the patient required a short (< or = 18-h) overnight stay because the procedure was completed too late in the day for recovery in the outpatient facility. The mean duration of observation was 4.8 +/- 1.5 h for outpatients and 15 +/- 1.4 h for patients who underwent overnight hospitalization. At follow-up study, two patients had a clinically significant complication; both had a femoral artery pseudoaneurysm detected > or = 1 week after the procedure and both required surgical repair. Thirty consecutive patients (22 outpatients and 8 hospitalized overnight) undergoing catheter ablation after January 1, 1992 were chosen for a cost analysis. The mean cost of the procedure was $10,183 +/- $1,082.

CONCLUSIONS

The majority of patients undergoing radiofrequency catheter ablation of an accessory AV connection can be treated safely on an outpatient basis.

摘要

目的

本研究旨在前瞻性评估137例门诊行房室旁道射频导管消融术的安全性、可行性及费用。

背景

医院内进行的射频消融术疗效显著且并发症发生率低，提示门诊进行该手术可能可行。

方法

在1991年9月1日至1992年4月20日期间进行的100例手术（73%）中，患者符合门诊治疗标准。排除标准为年龄<13岁或>70岁（4例）、房室旁道位于前间隔（5例）、肥胖（超过理想体重的30%）（4例）或有住院临床指征（24例）。仅行静脉穿刺的患者恢复期为3小时，行动脉穿刺的患者恢复期为6小时。患者中男性63例，女性32例（5例患者接受了间隔>1个月的两次消融手术），平均年龄±标准差为36±13岁。旁道位于左侧67例，右侧或后间隔33例。

结果

100例手术中97例成功，平均手术时间为99±42分钟。70例患者在消融当天出院，30例患者因手术完成时间过晚，门诊无法恢复，需短暂（≤18小时）过夜留院观察。门诊患者平均观察时间为4.8±1.5小时，过夜住院患者为15±1.4小时。随访研究中，2例患者出现临床显著并发症；均在术后≥1周发现股动脉假性动脉瘤，均需手术修复。选择1992年1月1日后连续30例行导管消融术的患者（22例门诊患者和8例过夜住院患者）进行费用分析。手术平均费用为10,183±1,082美元。