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目的评价既往颅内出血的心房颤动患者接受导管消融的安全性和有效性。方法连续入选2007年1月至2014年12月在北京安贞医院接受心房颤动导管消融且既往有颅内出血病史的患者22例。所有患者接受导管消融治疗,围术期采取停用华法林,应用低分子肝素抗凝。随访术后心律失常复发情况和临床预后。结果所有患者围术期均未发生严重出血或栓塞事件。1例患者术后发生心脏压塞,2例患者出现血管并发症。平均随访(28.9±10.7)个月,15例(68.2%)患者初次消融后维持窦性心律,2例(9.1%)复发患者接受再次消融后成功维持窦性心律,总体窦性心律维持率77.3%。所有患者术后均停用华法林,随访期间无栓塞和出血事件发生。结论既往有颅内出血病史的心房颤动患者接受导管消融是安全有效的,术后维持窦性心律可避免抗凝药物使用带来的出血风险。
Objective To evaluate the safety and efficacy of catheter ablation in patients with a prior intracranial hemorrhage of atrial fibrillation. Methods Twenty-two consecutive patients undergoing catheter ablation of atrial fibrillation and previous history of intracranial hemorrhage were enrolled in Anzhen Hospital, Beijing from January 2007 to December 2014. All patients received catheter ablation, perioperative withdrawal of warfarin, the application of low molecular weight heparin anticoagulation. Follow - up of recurrent arrhythmia and clinical prognosis. Results All patients had no major bleeding or embolism during perioperative period. One patient developed cardiac tamponade and two had vascular complications. The mean follow-up was (28.9 ± 10.7) months. Sinus rhythm was maintained in 15 patients (68.2%) after initial ablation, and sinus rhythm was maintained in 2 patients (9.1%) after reabsorption. The overall maintenance rate of sinus rhythm was 77.3 %. Warfarin was discontinued in all patients and no embolization or bleeding occurred during follow-up. CONCLUSIONS: Catheter ablation in patients with prior atrial fibrillation with a history of intracranial hemorrhage is safe and effective. Maintenance of sinus rhythm postoperatively avoids the risk of bleeding from anticoagulant use.