老年非瓣膜性心房颤动合并慢性心力衰竭患者行射频消融联合左心耳封堵术的安全性和有效性分析

Safety and Effectiveness of Radiofrequency Ablation Combined with Left Atrial Appendage Occlusion in Elderly Patients with Nonvalvular Atrial Fibrillation Complicated with Chronic Heart Failure

摘要: 目的：探讨老年非瓣膜性心房颤动(NVAF)合并慢性心力衰竭(CHF)患者行射频消融联合左心耳封堵术的安全性和有效性。方法：回顾性收集自2019年1月1日至2023年12月30日就诊于青岛大学附属医院行射频消融联合左心耳封堵术的年龄 ≥ 60岁的非瓣膜性房颤患者88例，根据是否合并CHF分为CHF组45例与非CHF组44例，另选取同期接受口服药物治疗年龄 ≥ 60岁的NVAF合并CHF患者(药物组) 49例作为对照组。收集三组临床基本资料，记录心衰组与非心衰组患者围术期不良事件，电话随访结合门诊随访方式随访，记录1年内三组主要不良心血管事件(MACE)发生率及再入院率情况并分析。结果：CHF组与非CHF组比较，手术并发症及围术期不良事件等发生率，差异无统计学意义(P > 0.05)。随访1年发现CHF组与非CHF组比较，MACE、再入院发生率差异无统计学意义(P > 0.05)。药物组MACE、心力衰竭、再入院发生率高于CHF组与非CHF组，差异有统计学差异(P < 0.05)。结论：射频消融联合左心耳封堵术对于老年非瓣膜性房颤合并慢性心力衰竭患者是一种安全有效的治疗方法，可有效降低主要心血管不良事件和再入院发生率。

Abstract: Objective: To investigate the safety and effectiveness of radiofrequency ablation combined with left atrial appendage occlusion in elderly patients with nonvalvular atrial fibrillation (NVAF) complicated with chronic heart failure (CHF). Methods: From January 1, 2019 to December 30, 2023, 88 patients with non-valvular atrial fibrillation aged ≥ 60 years who were treated with radiofrequency ablation combined with left atrial appendage occlusion in the Affiliated Hospital of Qingdao University were retrospectively collected. According to whether they were complicated with CHF, they were divided into CHF group (45 cases) and non-CHF group (44 cases), and 49 patients with NVAF complicated with CHF who were treated with oral drugs at the same time (drug group) were selected as the control group. The basic clinical data of three groups were collected, and the perioperative adverse events of patients in CHF group and non-CHF group were recorded. Telephone follow-up was combined with outpatient follow-up, and the incidence and readmission rate of major adverse cardiovascular events (MACE) in three groups were recorded and analyzed within one year. Results: Compared with the non-CHF group, there was no significant difference in the incidence of complications and perioperative adverse events in CHF group (P > 0.05). After a one-year follow-up, it was found that there was no significant difference in the incidence of MACE and readmission between CHF group and non-CHF group (P > 0.05). The incidence of MACE, chronic heart failure and readmission in drug group was higher than that in CHF group and non-CHF group, with statistical difference (P < 0.05). Conclusion: Radiofrequency ablation combined with left atrial appendage occlusion is a safe and effective treatment for elderly patients with nonvalvular atrial fibrillation complicated with chronic heart failure, which can effectively reduce the incidence of major cardiovascular adverse events and readmission.