摘要
目的分析心房颤动(AF)一站式术后Watchman 2.5封堵器中期内皮化的影响因素。方法回顾性纳入2019年2月至2024年6月在山东第一医科大学第一附属医院接受一站式治疗的非瓣膜性AF患者75例,收集患者的临床数据。术后6个月通过冠状动脉CT血管造影(CCTA)评估封堵情况,分为封堵器完全内皮化(CDE)组和不完全内皮化(IDE)组。采用二元Logistic回归分析术后封堵器内皮化的影响因素。结果纳入75例患者,术后随访中位时间6个月,CDE组患者38例,IDE组患者19例,18例患者存在器械残余分流(PDL)已排除。两组患者糖尿病占比比较,差异有统计学意义(P=0.030),一般资料、其他既往史、手术情况等比较,差异均无统计学意义(均P>0.05)。行二元Logistic回归分析,结果显示高血压(OR 8.347,95%CI 1.375~50.666,P=0.021)和糖尿病(OR 4.278,95%CI 1.108~16.512,P=0.035)为影响封堵器IDE的危险因素,而服用血管紧张素转换酶抑制剂/血管紧张素II受体拮抗剂(ACEI/ARB)类药物(OR 0.189,95%CI 0.043~0.833,P=0.028)和VOM无水乙醇化学消融(OR 0.110,95%CI 0.020~0.609,P=0.011)为保护因素。结论合并高血压和糖尿病可能会增加AF一站式术后封堵器中期IDE的风险,而服用ACEI/ARB类药物和VOM无水乙醇化学消融可能会降低这种风险。
Objective To analyze the influencing factors of mid-term occluder endothelialization after one-stop strategy for treatment of atrial fibrillation(AF)with Watchman 2.5 device.Methods A total of 75 non-valvular AF patients who underwent one-stop treatment in our hospital from February 2019 to June 2024 were retrospectively included.Clinical data of the patients were collected,including general information,past medical histories and procedual characteristics.At 6 months postoperatively,the occlusion status was evaluated via coronary 1computed tomography angiography(CCTA),classified into two groups:complete device endothelialization(CDE)and incomplete device endothelialization(IDE).Single-factor and multi-factor Logistic regression were employed to investigate the influencing factors of occluder endothelialization.Results 75 patients were included and followed up at a median time of 6 months after surgery.There were 38 patients in the CDE group and 19 patients in the IDE group.18 patients with residual shunt(PDL)were excluded.There were no significant differences in general information(age,sex,CHA2DS2-VASc score,HAS-BLED score),other past medical histories[hypertension,coronary heart disease,other cardiovascular diseases,history of stroke,history of bleeding,the use of statins and angiotensin converting enzyme inhibitor/angiotensinⅡreceptor blockers(ACEI/ARB)medications],type of AF,and whether they were combined with other types of arrhythmias(all P>0.05).However,when compared for diabetes,there was a statistically significant difference(P=0.030).There were no significant differences in the use of ICE guidance,vein of Marshall ethanol ablation,the morphology of the left atrial appendage and the model of the occluder implanted(all P>0.05).As CHA2DS2-VASc score,the use of ACEI/ARB medications,hypertension,diabetes,type of AF,vein of Marshall ethanol ablation for independent variables,and IDE after operation for the dependent variable,a single-factor and multi-factor Logistic regression was performed.The results showed that hypertension(OR 8.347,95%CI 1.375-50.666,P=0.021)and diabetes(OR 4.278,95%CI 1.108-16.512,P=0.035)are risk factors of IDE,while the use of ACEI/ARB medications(OR 0.189,95%CI 0.043-0.833,P=0.028)and vein of Marshall ethanol ablation(OR 0.110,95%CI 0.020-0.609,P=0.011)are protective factors.Conclusions Hypertension and diabetes may increase the risk of mid-term incomplete device endothelialization after one-stop treatment,while the use of ACEI/ARB medications and vein of Marshall ethanol ablation may reduce this risk.
作者
解文萱
李鑫玉
杨新宇
程诗琳
李欣然
王瑜
施钰根
王晔
薛梅
闫素华
胡和生
XIE Wen-xuan;LI Xin-yu;YANG Xin-yu;CHENG Shi-lin;LI Xin-ran;WANG Yu;SHI Yu-gen;WANG Ye;XUE Mei;YAN Su-hua;HU He-sheng(Department of Cardiology and Cardiac Arrhythmias,the First Affi liated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia,Jinan 250014,China)
出处
《中国介入心脏病学杂志》
2026年第1期20-26,共7页
Chinese Journal of Interventional Cardiology
基金
山东省自然科学基金面上项目(ZR2020MH024)
山东省医学会临床科研资金—齐鲁专项项目(YXH2022ZX02138)。
关键词
心房颤动
导管消融
左心耳封堵
内皮化
冠状动脉CT血管造影
Atrial fi brillation
Catheter ablation
Left atrial appendage occlusion
Endothelialization
Coronary CT angiography
