房颤患者术后医源性房间隔缺损发生情况及影响因素分析

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摘要目的了解房颤患者术后医源性房间隔缺损（ASD）的发生情况及影响因素，为医源性ASD的预防和治疗提供依据。方法选取2014年12月~2017年12月大连医科大学附属第一医院行房间隔穿刺术的118例房颤患者纳入研究。根据术后经胸超声心动图（TTE）或经食道超声心动图（TEE）检测结果，将患者分为医源性ASD组（n = 18）及正常愈合组（n = 83），比较两组临床资料，分析医源性ASD的影响因素。对医源性ASD患者进行3个月的随访，观察医源性ASD患者预后。结果医源性ASD组术式均为射频消融术，剔除正常愈合组行左心耳封堵术10例及冷冻球囊消融术7例。随访3个月发现有1例出现腔隙性脑梗死，2例偏头痛。医源性ASD组中持续性房颤发生率、国际标准化比值高于正常愈合组（P < 0.05），左房内径大于正常愈合组（P < 0.05）。logistic回归分析显示左房内径＞38 mm是发生医源性ASD的独立危险因素（OR = 1.119，95%CI：1.006~1.245，P = 0.038）。结论房颤射频消融术后医源性ASD较为常见，左房内径增大是导致医源性ASD的独立危险因素，医源性ASD仍可以导致临床事件发生，应引起重视。

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	武思雯1 张荣峰2 尹晓盟2 董颖雪2 肖宪杰2 高连君2

关键词 ：心房颤动, 房间隔穿刺术, 医源性房间隔缺损, 导管消融

Abstract：Objective To investigate the occurrence and influencing factors of postoperative iatrogenic atrial septal defect (ASD) in patients with atrial fibrillation, and to provide evidence for the prevention and treatment of iatrogenic ASD. Methods From December 2014 to December 2017, 118 cases with atrial fibrillation who underwent atrial septal puncture in the First Affiliated Hospital of Dalian Medical University were selected. According to the results of transthoracic echocardiography(TTE) or transesophageal echocardiography(TEE), they were divided into iatrogenic ASD group (n = 18) and normal healing group (n = 83). The clinical data of two groups were compared and the influencing factors of iatrogenic ASD were analyzed. The patients with iatrogenic ASD were followed up for 3 months and the prognosis was observed. Results In iatrogenic ASD group, all patients underwent radiofrequency ablation. Ten cases who underwent left atrial appendage occlusion and 7 cases who underwent frozen balloon ablation were excluded in normal healing group. Patients with iatrogenic ASD were followed up for 3 months, 1 case had lacunar cerebral infarction and 2 cases had migraine. The incidence of persistent atrial fibrillation and international normalized ratio in iatrogenic ASD group was higher than that in normal healing group (P < 0.05), and the left atrial diameter was larger than that in normal healing group (P < 0.05). Logistic regression analyze showed that left atrial diameter＞38 mm was an independent risk factor for iatrogenic ASD (OR = 1.119, 95%CI:1.006-1.245, P = 0.038). Conclusion Iatrogenic ASD is frequent after radiofrequency ablation of atrial fibrillation. The increase of left atrial diameter is an independent risk factor for iatrogenic ASD. Iatrogenic ASD can still lead to clinical events, which should be paid more attention.

Key words： Atrial fibrillation Atrial septal puncture Iatrogenic atrial septal defect Catheter ablation

基金资助:国家自然科学基金资助项目（81800294）。

通讯作者: 张荣峰（1985-），男，博士，副教授；研究方向：心脏电生理与起搏。

作者简介: 武思雯（1992-），女，硕士；研究方向：心内科。

引用本文:

武思雯1 张荣峰2 尹晓盟2 董颖雪2 肖宪杰2 高连君2. 房颤患者术后医源性房间隔缺损发生情况及影响因素分析[J]. 中国医药导报, 2020, 17(11): 44-47.
WU Siwen1 ZHANG Rongfeng2 YIN Xiaomeng2 DONG Yingxue2 XIAO Xianjie2 GAO Lianjun2. Analysis of the occurrence and influencing factors of postoperative iatrogenic atrial septal defect in patients with atrial fibrillation. 中国医药导报, 2020, 17(11): 44-47.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I11/44

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