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Europace：不间断抗凝的AF消融患者仍有无症状性脑损伤风险

2013-03-13 Europace 丁香园

Europace抗凝脑损伤
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两例代表性急性脑栓塞 已经证实在左房的射频消融可导致无症状性脑损伤风险。目前尚无在不间断口服抗凝治疗的患者接受AF射频消融过程中发生脑损伤的资料。奥地利的研究人员Martin Martinek等开展的这项研究的目的旨在通过术前和术后核磁共振（MRI）对国际标准化比值（INR）治疗范围内的无症状性脑损伤患者发生情况进行量化来寻找与脑栓塞相关的临床或者手术影响因素。其结果发表在在2013年3月的


两例代表性急性脑栓塞

已经证实在左房的射频消融可导致无症状性脑损伤风险。目前尚无在不间断口服抗凝治疗的患者接受AF射频消融过程中发生脑损伤的资料。奥地利的研究人员Martin Martinek等开展的这项研究的目的旨在通过术前和术后核磁共振（MRI）对国际标准化比值（INR）治疗范围内的无症状性脑损伤患者发生情况进行量化来寻找与脑栓塞相关的临床或者手术影响因素。其结果发表在在2013年3月的Europace杂志上。

研究共纳入连续的131例接受导管射频消融的阵发性房颤患者（n=80,61.1%）或者持续性房颤患者（n=51,38.9%）。利用3.5mm开放式灌注导管根据具体情况行肺静脉前庭（PVI）、顶部线、二尖瓣峡部线、以及碎裂点位（CFAE）消融。所有的患者均接受术前和术后头颅MRI。术后MRI发现16例患者出现新的栓塞性病变（12.2%），但他们均无症状。在单因素分析中，临床资料中的年龄（P = 0.027）、持续性房颤（与阵发性AF对比；P = 0.039）、经食道超声心动图时自主回声增强（P = 0.029）与脑栓塞明显相关。有意义的术中影响因素有电复律（P = 0.041）、仅行PVI（P = 0.008）以及碎裂电位消融（P = 0.005）。多因素分析中，独立的危险因素为年龄（P = 0.009）、自主回声增强（P = 0.029）和 CFAE消融（P = 0.006）。

不间断口服抗凝治疗的房颤患者接受射频消融术仍有较大的无症状脑栓塞风险（头颅MRI检查发现）。因此，持续口服抗凝不能预防脑栓塞发生。多种不同的临床和手术因素共同导致脑损伤风险。
与脑损伤相关的拓展阅读：

AIMS:
Left atrial radiofrequency ablation has been shown to carry a risk of asymptomatic cerebral lesions. No data exist in patients under continued oral anticoagulation during the ablation procedure. The aim of this study was to quantify the amount of silent cerebral lesions assessed by pre-procedural and post-procedural magnetic resonance imaging (MRI) in patients under therapeutic international normalized ratio (INR) and to identify clinical or procedural parameters that correlate with cerebral embolism.
METHODS AND RESULTS:
A total of 131 consecutive patients undergoing catheter ablation for paroxysmal (n = 80, 61.1%) or persistent (n = 51, 38.9%) atrial fibrillation were included in the study. Pulmonary vein antrum isolation (PVI), roofline, mitral isthmus line, and complex fractionated atrial electrogram (CFAE) ablation using 3.5 mm open-irrigated tip catheters were performed, as needed. All patients underwent pre-procedural and post-procedural cerebral MRI. Post-procedural MRI revealed new embolic lesions in 16 patients (12.2%), all of them asymptomatic. Clinical parameters showing a significant correlation with cerebral embolism in univariate analysis were age (P = 0.027), persistent atrial fibrillation (vs. paroxysmal; P = 0.039), and spontaneous echo contrast in transesophageal echocardiography (P = 0.029). Significant procedural parameters were electric cardioversion (P = 0.041), PVI only (P = 0.008), and ablation of complex atrial electrograms (P = 0.005). Independent risk factors in multivariate analysis were age (P = 0.009), spontaneous echo contrast (P = 0.029) and CFAE ablation (P = 0.006).
CONCLUSION:
Radiofrequency ablation in patients under continued oral therapeutic anticoagulation is associated with a substantial risk of silent embolism detected by cerebral MRI. Therefore, continuation of oral anticoagulation is not able to prevent cerebral embolism. A variety of different clinical and procedural factors seem to contribute to the risk of cerebral lesions.

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    2013-10-29 TZF0811

    #间断#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1632767, encodeId=f4b31632e67d0, content=<a href='/topic/show?id=10a09e25096' target=_blank style='color:#2F92EE;'>#间断#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97250, encryptionId=10a09e25096, topicName=间断)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86a21951359, createdName=TZF0811, createdTime=Tue Oct 29 23:50:00 CST 2013, time=2013-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655667, encodeId=c6da165566eea, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Sat Mar 16 00:50:00 CST 2013, time=2013-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396753, encodeId=aa971396e539a, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Fri Mar 15 02:50:00 CST 2013, time=2013-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421553, encodeId=735d1421553f6, content=<a href='/topic/show?id=4bc865819d2' target=_blank style='color:#2F92EE;'>#消融#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65819, encryptionId=4bc865819d2, topicName=消融)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a193676008, createdName=xiangyuzhou972, createdTime=Fri Mar 15 02:50:00 CST 2013, time=2013-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1484917, encodeId=61ed148491eb8, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Fri Mar 15 02:50:00 CST 2013, time=2013-03-15, status=1, ipAttribution=)]
    2013-03-16 shanyongle

    #ACE#

    0

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    2013-03-15 智者为医08

    #损伤#

    0

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    2013-03-15 xiangyuzhou972

    #消融#

    0

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    2013-03-15 12498da4m34(暂无昵称)

    #无症状#

    0