房颤患者有发生脑血管栓塞事件(cerebrovascular embolic events, CVEs)的风险,包括卒中和短暂性脑缺血发作。口服抗凝药物治疗(oral anticoagulation therapy, OAT)可以有效地预防CVE,而导管消融(catheter ablation, CA)治疗房颤已成为部分患者最有效的节律控制策略。尽管有回顾性研究认为通过CA消除房颤或减轻房颤负担可能会显著降低卒中风险,然而在导管消融成功后是否可以安全地停止OAT仍然是一个有争议的话题。
Patients with atrial fibrillation are at risk for thromboembolic events (cerebrovascularembolicevents, CVEs), including stroke and transient ischemic attacks. Anticoagulant therapy (oralanticoagulation therapy, OAT) can effectively prevent CVE, catheter ablation (catheterablation, CA) in the treatment of atrial fibrillation has become the most effective rhythm control strategy for some patients. Although retrospective studies have suggested that eliminating atrial fibrillation or reducing the burden of atrial fibrillation through CA may significantly reduce stroke risk, whether OAT can be stopped safely after successful catheter ablation is still a controversial topic.
Patients with atrial fibrillation are at risk for thromboembolic events (cerebrovascularembolicevents, CVEs), including stroke and transient ischemic attacks. Anticoagulant therapy (oralanticoagulation therapy, OAT) can effectively prevent CVE, catheter ablation (catheterablation, CA) in the treatment of atrial fibrillation has become the most effective rhythm control strategy for some patients. Although retrospective studies have suggested that eliminating atrial fibrillation or reducing the burden of atrial fibrillation through CA may significantly reduce stroke risk, whether OAT can be stopped safely after successful catheter ablation is still a controversial topic.
Saliba [15] 等人对969名接受房颤消融术的房颤患者进行了队列研究,并将结果与3772名未接受房颤消融术的房颤患者的倾向匹配组进行了比较,发现在这一主要为高危患者的组中(83.4%的CHA2DS2-VASc评分 ≥ 2),接受消融术治疗的患者比未接受房颤消融术的患者在随访期间出现CVE的可能性更小(HR 0.61,95% CI 0.48~0.79)。
在最近发表的具有里程碑意义的CABANA (心房颤动的导管消融与抗心律失常药物治疗)试验中,2204名有症状的房颤患者随机接受消融或抗心律失常药物治疗,卒中致残的发生率(0.3%:0.6%; p = 0.38)或严重出血(3.2% vs. 3.3%; p = 0.93)没有显著差异。然而,考虑到事件发生率很低,这项研究无法确定导管消融是否真的降低了房颤患者的长期卒中风险 [16]。
王丽娟,汪 敏,双东思. 房颤导管消融成功后抗凝Anticoagulation after Successful Catheter Ablation of Atrial Fibrillation[J]. 临床医学进展, 2020, 10(09): 1892-1898. https://doi.org/10.12677/ACM.2020.109284
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