Abstract：【Objective】To investigate the risk factors of acute cerebrovascular events after catheter radiofrequency ablation (RFCA) in elderly patients with atrial fibrillation (AF). 【Methods】The general data of 141 elderly AF patients treated with RFCA from March 2017 to March 2021 were analyzed retrospectively. Patients were divided into the control group (n=117) and the observation group (n=24) according to the results of 6-month follow-up. Multiple Logistic regression analysis was used to analyze the risk factors of acute cerebrovascular events in elderly AF patients after RFCA. 【Results】Compared to the control group, the proportion of patients with persistent AF and patients with previous stroke increased in the observation group ( P<0.05). Previous stroke history and persistent AF were independent risk factors for acute cerebrovascular events in elderly AF patients after RFCA (OR=3.968,95%CI=1.472~10.697;OR=2.587, 95%CI=1.357~4.929, respectively, P<0.05). There were 24 cases of acute cerebrovascular events in the observation group. Of which, 13 cases had cerebral infarction within 24 hours, 2 cases occurred during operation, 7 cases occurred between 24 hours and 72 hours, 2 cases occurred between 8 days and 16 days, and 20 cases had cerebral infarction, there were 2 cases of transient cerebral ischemia attack and 2 cases of cerebral infarction with hemorrhage transformation. The NIHSS score was 1~20 (mean:7.52±6.37) in hospitalized patients with acute cerebrovascular events. When patients were discharged, they had the NIHSS score of 0~12 (mean: 3.95±3.63) with acute cerebrovascular events. There were 4 cases with complete recovery of neurological function. 【Conclusion】 Persistent AF and previous history of stroke are independent risk factors of acute cerebrovascular events after RFCA, which can increase the length of hospital stay and mortality.
[1] POOLE J E, BAHNSON T D, MONAHAN K H, et al. Recurrence of atrial fibrillation after catheter ablation or antiarrhythmic drug therapy in the CABANA trial[J].J Am Coll Cardiol,2020, 75(25):3105-3118.
[2] TUNG R. Percutaneous epicardial ablation of atrial fibrillation[J].Card Electrophysiol Clin,2020, 12(3):371-381.
[3] 陈晓峰, 张相友, 鲁晓花, 等. 卒中后抑郁患者的生存质量及其相关因素探讨以及不同抗抑郁药物疗效比较[J].山西医药杂志, 2015, 62(10):1139-1141.
[4] 武冬冬, 胡夏生, 刘银红, 等. 脑微出血的临床意义及其伴心房颤动时的抗凝治疗决策进展[J].诊断学理论与实践, 2020, 19(5):96-101.
[5] 石同欢, 黄鹤. 射血分数保留心力衰竭伴心房颤动的临床治疗和预防研究进展[J].中华心律失常学杂志, 2020, 24(2):181-184.
[6] 陈力, 陈智芳, 尹克春. 229例心房颤动患者病例回顾性分析[J].中国保健营养, 2012, 76(8):1-2.
[7] 曾进胜, 蒲传强. 我国各类主要脑血管病诊断要点演变与更新[J].中华神经科杂志, 2019, 52(9):681-683.
[8] SEPEHRI SHAMLOO A, BOLLMANN A, DAGRES N, et al. Natriuretic peptides: biomarkers for atrial fibrillation management[J].Clin Res Cardiol,2020, 109(8):957-966.
[9] MANOLIS T A, MANOLIS A A, APOSTOLOPOULOS E J, et al. Atrial fibrillation and cognitive impairment: an associated burden or burden by association?[J].Angiology,2020, 71(6):498-519.
[10] VALDERRÁBANO M, PETERSON L E, SWARUP V, et al. Effect of catheter ablation with vein of marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: the VENUS randomized clinical trial[J].JAMA,2020, 324(16):1620-1628.
[11] HALDAR S, KHAN H R, BOYALLA V, et al. Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial[J].Eur Heart J,2020, 41(47):4471-4480.
[12] 李冰. 心功能不全与心房颤动患者心脏导管射频消融术后急性缺血性脑卒中发病探讨[J].现代医用影像学, 2018, 27(8):371-372.
[13] 吴岩熹, 刘凡, 鲁静朝, 等. 单中心非瓣膜性心房颤动患者卒中评分对比及药物抗凝治疗现状统计分析[J].中国心脏起搏与心电生理杂志, 2018, 32(1):18-21.
[14] DINOV B, KOSIUK J, KIRCHER S, et al. Impact of metabolic syndrome on left atrial electroanatomical remodeling and outcomes after radiofrequency ablation of nonvalvular atrial fibrillation[J].Circ Arrhythm Electrophysiol,2014, 7(3):483-489.
[15] 张欣炀. 脑卒中相关危险因素筛查与社区人群干预研究现状[J].世界最新医学信息文摘, 2019, 19(8):88-93.
[16] 李旭霞. 经食道超声对射频消融术前房颤患者左房及左心耳血栓的诊断价值分析[J].影像研究与医学应用, 2020, 4(9):247-248.
[17] 顾立华, 化学胜. 肥厚型心肌病并持续性心房颤动患者远期预后的危险因素研究[J].实用心脑肺血管病杂志, 2020, 28(12):16-20.
2021, Vol. 38 
