Objective: To assess the efficacy and safety of "one-stop" procedures combining radiofrequency catheter ablation and left atrial appendage closure by guidance of intracardiac echocardiography(ICE) in elderly patients with atrial fibrillation. Methods: A retrospective cohort study was conducted on patients who underwent ICE-guided "one-stop" procedures at the Department of Cardiology, General Hospital of Northern Theater Command between December 2020 and January 2023. Patients were divided into elderly group (age≥60 years old) and non-elderly group (age 18-59 years old). The clinical characteristics, acute success rate, peri-operative complications and follow-up data between two groups were compared. Multivariate logistic regression analysis was used to analyze whether age was the influencing factor for perioperative complications and atrial fibrillation recurrence. Results: A total of 213 atrial fibrillation patients were enrolled, including 158 (74.18%) in the elderly group (age: (68.3±5.0) years; 56.96% male) and 55 (25.82%) in the non-elderly group (age: (53.7±5.2) years; 81.82% male). The elderly group had lower proportions of males, persistent atrial fibrillation, and left atrial spontaneous echocardiographic contrast compared to the non-elderly group (P<0.05). CHA2DS2-VASc and HAS-BLED scores were higher in elderly group (P<0.05). The acute success rate,"one-stop" procedure time, fluoroscopy time and the rate of peri-operative complications (6 (3.80%) in elderly group vs. 2 (3.64%) in non-elderly group) were similar between two groups (all P>0.05). The average time of clinical and telephone interviews in elderly group and non-elderly group was (16.9±6.1) months and (17.9±5.9) months, respectively. There was no significant difference in the rate of atrial fibrillation recurrence or clinical events between two groups (47 (30.72%) vs. 14 (26.42%), P=0.554; 10 (6.54%) vs. 2(3.77%), P=0.689, respectively). Iatrogenic atrial septal defects in 3-month transesophageal echocardiography follow up were detected in 44 patients (36.97%) in elderly group and 9 patients (19.57%) in non-elderly group (P=0.032). Multivariate logistic regression analysis results showed that age was not the influencing factor for peri-operative complications and atrial fibrillation recurrence (P=0.905 and P=0.676, respectively). Conclusion: Intracardiac echocardiography-guided "one-stop" procedures in the treatment of atrial fibrillation in elderly patients are safe and effective.
目的： 评估老年心房颤动（房颤）患者行心腔内超声指导下射频消融联合左心耳封堵“一站式”手术的疗效及安全性。 方法： 本研究为回顾性队列研究，回顾分析2020年12月至2023年1月于解放军北部战区总医院心血管内科行心腔内超声指导下“一站式”手术治疗的房颤患者，根据年龄分为老年组（年龄≥60岁）及非老年组（年龄18~59岁），比较2组患者的临床特征、手术即刻成功率、围术期并发症及术后随访结果。采用多因素logistic回归分析年龄是否为围术期并发症及术后房颤复发的影响因素。 结果： 共纳入213例房颤患者，其中老年组158例（74.18%），年龄（68.3±5.0）岁，男性90例（56.96%）；非老年组55例（25.82%），年龄（53.7±5.2）岁，男性45例（81.82%）。老年组患者中男性、持续性房颤及有左心耳红细胞自发显影的比例均低于非老年组（P<0.05），CHA2DS2-VASc评分及HAS-BLED评分高于非老年组（P<0.05）。老年组和非老年组的消融手术即刻成功率、“一站式”手术时间、X线曝光时间及围术期并发症发生率［6例（3.80%）比2例（3.64%）］差异无统计学意义（P均>0.05）；2组患者分别接受门诊或电话随访（16.9±6.1）个月及（17.9±5.9）个月，患者房颤复发率及不良事件发生率比较差异无统计学意义［47例（30.72%）比14例（26.42%），P=0.554；10例（6.54%）比2例（3.77%），P=0.689］。术后3个月经食道超声心动图随访结果提示，老年组医源性房间隔缺损发生率高于非老年组［44例（36.97%）比9例（19.57%），P=0.032］。多因素logistic回归分析结果显示，年龄不是围术期并发症及术后房颤复发的影响因素（P=0.905、0.676）。 结论： 老年患者行心腔内超声指导下射频消融联合左心耳封堵“一站式”手术治疗房颤同样是安全有效的。.