心房颤动冷冻球囊消融术中采用低激活全血凝固时间目标值的安全性
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摘要
目的评价低的激活全血凝固时间(ACT)在心房颤动(简称房颤)冷冻球囊治疗中的安全性。方法纳入本科诊断为房颤行冷冻球囊消融治疗的患者155例,术前随机分为A、B两组。A组78例,ACT维持在250～300 s;B组77例,ACT维持在300～350 s。观察患者术中、住院期间以及出院1个月内出血及缺血事件的发生情况并予以统计学分析。结果 B组较A组住院期间股静脉穿刺部位出血发生率高(13.0%vs 1.3%,P<0.05),其他部位出血事件(如脑出血、心包积液、皮肤黏膜出血等)无差异。经性别分组后,男性及女性患者ACT达标率无差异(86.76%±16.56%vs 91.26%±14.57%,P>0.05),但女性患者术中肝素总量少于男性[(7 889.71±1 712.22)U vs (9 372.99±1 999.85)U,P<0.05]。结论冷冻球囊消融治疗房颤时ACT维持在250～300 s是安全的,女性患者术中ACT更易达标。
Objective To evaluate safety of lower activated clotting times(ACT) in atrial fibrillation patients undergoing cryoballoon ablation. Methods One Hundred and fifty-five patients with atrial fibrillation scheduled for cryoballoon ablation were enrolled. Subjects were randomized according to ACT during cryoballoon procedure [group A(n=78) of ACT 250-300 s and group B(n=77) of ACT 300-350 s]. Hemorrhagic and ischemic events during procedure, in-hospital and within one month were recorded and analyzed. Results Incidence of hemorrhage in groin was higher in group B(13.0% vs 1.3%,P<0.05). There were no differences in the incidence of other kind of hemorrhage events, such as cerebral hemorrhage and pericardial effusion. There was no difference in the level of heparinization between men and women(86.76%±16.56% vs 91.26%±14.57%,P>0.05), but total heparin dose was more in men [(7 889.71±1712.22)U vs(9372.99±1999.85)U, P<0.05]. Conclusions Lower ACT(<300 seconds) are safe in cryoballoon ablation procedure, women receive less heparin.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(2):119-122]
Objective To evaluate safety of lower activated clotting times(ACT) in atrial fibrillation patients undergoing cryoballoon ablation. Methods One Hundred and fifty-five patients with atrial fibrillation scheduled for cryoballoon ablation were enrolled. Subjects were randomized according to ACT during cryoballoon procedure [group A(n=78) of ACT 250-300 s and group B(n=77) of ACT 300-350 s]. Hemorrhagic and ischemic events during procedure, in-hospital and within one month were recorded and analyzed. Results Incidence of hemorrhage in groin was higher in group B(13.0% vs 1.3%,P<0.05). There were no differences in the incidence of other kind of hemorrhage events, such as cerebral hemorrhage and pericardial effusion. There was no difference in the level of heparinization between men and women(86.76%±16.56% vs 91.26%±14.57%,P>0.05), but total heparin dose was more in men [(7 889.71±1712.22)U vs(9372.99±1999.85)U, P<0.05]. Conclusions Lower ACT(<300 seconds) are safe in cryoballoon ablation procedure, women receive less heparin.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(2):119-122]
引文
1 Kuck KH,Brugada J,Furnkranz A,et al.Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation[J].The New England Journal of Medicine,2016,374(23):2 235
2 Calkins H,Hindricks G,Cappato R,et al.2017 HRS/EHRA/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J].Europace,2018,20(1):e1
3 Hisazaki K,Hasegawa K,Kaseno K,et al.Endothelial damage and thromboembolic risk after pulmonary vein isolation using the latest ablation technologies:a comparison of the second-generation cryoballoon vs.contact force-sensing radiofrequency ablation [J].Heart Vessels,2019,34(3):509
4 Su W,Aryana A,Passman R,et al.Cryoballoon best practices II:practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective pf experienced users[J].Heart Rhythm,2018,15(9):1 348
5 黄从新,张澎,马长生,等.中国经射频导管消融治疗心房颤动注册研究10年回顾[J].中华心律失常学杂志,2009,13(3):296
6 Cappato R,Calkins H,Chen SA,et al.Updated worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation[J].Circulation.Arrhythmia and Electrophysiology,2010,3(1):32
7 Nakamura K,Sasaki T,Take Y,et al.Post-ablation cerebral embolisms in balloon-based atrial fibrillation ablation with periprocedural direct oral anticoagulants:a comparison between cryoballoon and hot-balloon ablation [J].Journal of Cardiovascular Electrophysiology,2019,30(1):39
8 Baltogiannis G,Chierchia GB,Conte G,et al.The role of novel oral anticoagulants in patients undergoing cryoballoon ablation for atrial fibrillation[J].Hellenic Journal of Cardiology,2016,57(5):331
9 Koektuerk B,Turan CH,Yorgun H,et al.The total incidence of complications and the impact of an anticoagulation regime on adverse events after cryoballoon ablation of atrial fibrillation:a single-center study of 409 patients[J].Cardiovascular Therapeutics,2016,34(3):144
10 Tscholl V,Lsharaf AK,Lin T,et al.Apixaban,rivaroxaban,and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second-generation cryoballoon[J].Clinical Cardiology,2017,40(11):1 095
11 Bernelli C,Chieffo A,Montorfano M,et al.Usefulness of baseline activated clotting time-guided heparin administration in reducing bleeding events during transfemoral transcatheter aortic valve implantation[J].JACC Cardiovascular Interventions,2014,7(2):140
12 Campbell NRC,Hull RD,Brant R,et al.Different effects of heparin in males and females [J].Clinical and Investigative Medicine,1998,21(2):71
13 Thalhammer C,Kirchherr AS,Uhlich F,et al.Post-catheterization pseudoaneurysms and arteriovenous fistulas:repair with percutaneous implantation of endovascular covered stents[J].Radiology,2000,214(1):127
14 Kulkarni N,Su W,Wu R.How to prevent,detect and manage complications caused by cryoballoon ablation of atrial fibrillation[J].Arrhythmia and Electrophysiology Review,2018,7(1):18
15 Guijian L,Wenqing Z,Xinggang W,et al.Association between ablation technology and asymptomatic cerebral injury following atrial fibrillation ablation[J].Pacing and Clinical Electrophysiology,2014,37(10):1 378
2 Calkins H,Hindricks G,Cappato R,et al.2017 HRS/EHRA/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J].Europace,2018,20(1):e1
3 Hisazaki K,Hasegawa K,Kaseno K,et al.Endothelial damage and thromboembolic risk after pulmonary vein isolation using the latest ablation technologies:a comparison of the second-generation cryoballoon vs.contact force-sensing radiofrequency ablation [J].Heart Vessels,2019,34(3):509
4 Su W,Aryana A,Passman R,et al.Cryoballoon best practices II:practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective pf experienced users[J].Heart Rhythm,2018,15(9):1 348
5 黄从新,张澎,马长生,等.中国经射频导管消融治疗心房颤动注册研究10年回顾[J].中华心律失常学杂志,2009,13(3):296
6 Cappato R,Calkins H,Chen SA,et al.Updated worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation[J].Circulation.Arrhythmia and Electrophysiology,2010,3(1):32
7 Nakamura K,Sasaki T,Take Y,et al.Post-ablation cerebral embolisms in balloon-based atrial fibrillation ablation with periprocedural direct oral anticoagulants:a comparison between cryoballoon and hot-balloon ablation [J].Journal of Cardiovascular Electrophysiology,2019,30(1):39
8 Baltogiannis G,Chierchia GB,Conte G,et al.The role of novel oral anticoagulants in patients undergoing cryoballoon ablation for atrial fibrillation[J].Hellenic Journal of Cardiology,2016,57(5):331
9 Koektuerk B,Turan CH,Yorgun H,et al.The total incidence of complications and the impact of an anticoagulation regime on adverse events after cryoballoon ablation of atrial fibrillation:a single-center study of 409 patients[J].Cardiovascular Therapeutics,2016,34(3):144
10 Tscholl V,Lsharaf AK,Lin T,et al.Apixaban,rivaroxaban,and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second-generation cryoballoon[J].Clinical Cardiology,2017,40(11):1 095
11 Bernelli C,Chieffo A,Montorfano M,et al.Usefulness of baseline activated clotting time-guided heparin administration in reducing bleeding events during transfemoral transcatheter aortic valve implantation[J].JACC Cardiovascular Interventions,2014,7(2):140
12 Campbell NRC,Hull RD,Brant R,et al.Different effects of heparin in males and females [J].Clinical and Investigative Medicine,1998,21(2):71
13 Thalhammer C,Kirchherr AS,Uhlich F,et al.Post-catheterization pseudoaneurysms and arteriovenous fistulas:repair with percutaneous implantation of endovascular covered stents[J].Radiology,2000,214(1):127
14 Kulkarni N,Su W,Wu R.How to prevent,detect and manage complications caused by cryoballoon ablation of atrial fibrillation[J].Arrhythmia and Electrophysiology Review,2018,7(1):18
15 Guijian L,Wenqing Z,Xinggang W,et al.Association between ablation technology and asymptomatic cerebral injury following atrial fibrillation ablation[J].Pacing and Clinical Electrophysiology,2014,37(10):1 378