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目的分析肺癌外科术后合并心房颤动(房颤)患者的临床及电生理特征,并评价此类患者接受导管消融治疗的效果。方法共入选14例肺癌外科术后合并房颤行导管消融的患者(观察组),按照1∶2随机选取同期入院消融的无肺部手术史的房颤患者作为对照组。所有患者均行导管消融,并随访心律失常复发情况。结果观察组患者体质量指数小于对照组[(23.6±3.1)kg/m2比(26.3±2.8)kg/m2,P=0.006],而合并糖尿病患者多于对照组(35.7%比7.1%,P=0.019);心房扑动或房性心动过速等在观察组患者中更为常见(64.3%比17.9%,P=0.002),且房颤相关症状更为严重。观察组患者的导管消融总手术时间及X线透视时间均高于对照组,差异有统计学意义[(197.5±73.2)min比(169.5±65.3)min,P<0.01]和[(45.7±28.5)min比(32.0±26.8)min,P<0.05]。随访期间,观察组和对照组分别有9例(64.3%)和14例(50.0%)复发心律失常。观察组患者单次消融的窦性心律维持率略低于对照组(35.7%比50.0%,P=0.185),但差异无统计学意义。结论对于肺癌外科术后合并房颤的患者,尽管单次消融成功率略低,导管消融仍是一种安全有效的治疗手段。
Objective To analyze the clinical and electrophysiological characteristics of patients with atrial fibrillation (AF) after lung surgery and to evaluate the effect of catheter ablation in such patients. Methods A total of 14 patients with atrial fibrillation undergoing lung cancer surgical resection and catheter ablation (observation group) were enrolled in this study. Atrial fibrillation patients with no previous history of pulmonary surgery underwent admission at 1: 2 were randomly selected as the control group. All patients underwent catheter ablation, and follow-up of arrhythmia recurrence. Results The body mass index of the observation group was significantly lower than that of the control group [(23.6 ± 3.1) kg / m2 (26.3 ± 2.8) kg / m2, P = 0.006] = 0.019). Atrial flutter or atrial tachycardia was more common in the observation group (64.3% vs. 17.9%, P = 0.002), and the symptoms associated with atrial fibrillation were more severe. The total duration of catheter ablation and X-ray fluoroscopy in observation group were significantly higher than those in control group [(197.5 ± 73.2) min vs (169.5 ± 65.3) min, P <0.01 and [45.7 ± 28.5 ) min than (32.0 ± 26.8) min, P <0.05]. During the follow-up period, there were 9 cases (64.3%) and 14 cases (50.0%) of recurrent arrhythmia in observation group and control group respectively. The maintenance rate of sinus rhythm of single ablation in observation group was slightly lower than that in control group (35.7% versus 50.0%, P = 0.185), but the difference was not statistically significant. Conclusions Catheter ablation remains a safe and effective treatment for patients with atrial fibrillation after surgery for lung cancer despite a slightly lower success rate of single ablation.