目的：探讨心房颤动患者心脏导管射频消融术（RFCA）后住院期间急性缺血性脑卒中的发病率及其影响因素。方法回顾性分析2012年1月—2015年12月北京安贞医院心内科出院诊断中包括“阵发性或持续性心房颤动”并实施 RFCA 的住院患者4573例，根据 RFCA 后住院期间是否发生急性缺血性脑卒中分为卒中组及对照组，记录患者的性别、年龄、既往史和合并症、心房颤动类型、手术次数、住院时间、院内病死率、入院及出院时日常生活能力（ADL）评分。结果4573例发生急性缺血性脑卒中患者22例（卒中组），发病率为0.48%，其中脑梗死19例（0.41%），短暂性脑缺血发作（TIA）3例（0.07%）；其余4551例未发生急性缺血性脑卒中患者为对照组。对照组与卒中组患者性别、年龄、既往高血压、糖尿病、高脂血症、冠心病、心脏瓣膜病发病率、手术次数比较，差异均无统计学意义（P >0.05）；对照组与卒中组患者既往缺血性脑卒中、心功能不全发病率、心房颤动类型比较，差异均有统计学意义（P <0.05）。多因素 Logistic 回归分析结果显示，既往缺血性脑卒中病史〔OR =21.342，95% CI（6.549，69.546）〕、心功能不全〔OR =8.782，95% CI（3.173，24.308）〕、持续性心房颤动〔 OR =2.990，95% CI（1.137，7.860）〕是心房颤动患者 RFCA 后住院期间并发急性缺血性脑卒中的独立危险因素（P <0.05）。卒中组患者住院时间长于对照组〔13（24）d 与5（2）d〕，院内病死率高于对照组〔9.09%（2/22）与0.13%（6/4551）〕，出院时 ADL评分低于对照组〔（89.8±14.6）分与（99.1±4.1）分〕（P <0.05）。结论心房颤动患者 RFCA 后住院期间急性缺血性脑卒中总体发病率较低，但并发急性缺血性脑卒中延长了住院时间，增加了院内病死率，影响患者生活能力；既往缺血性脑卒中病史、心功能不全、持续性心房颤动是 RFCA 后住院期间并发急性缺血性脑卒中的独立危险因素，术前筛选和严格掌握适应证有助于减少 RFCA 后并发急性缺血性脑卒中。%Objective To investigate the incidence of acute ischemic stroke in patients with atrial fibrilation after radio frequency catheter ablation(RFCA)and to explore the influencing factors. Methods A retrospective analysis was performed on 4 573 inpatients who were diagnosed as paroxysmal or consistent atrial fibrillation and received RFCA in the Department of Cardiovascular Medicine of Beijing Anzhen Hospital,Capital Medical University from January 2012 to December 2015. According to whether acute ischemic stroke occurred during hospitalization after RFCA,we divided the patients into stroke group and control group. We recorded gender,age,medical history and complications,atrial fibrilation type,times of surgery,hospitalization time,case fatality rate in the hospital,and ADL score at admission and discharge. Results Among the 4 573 patients,22 patients had acute ischemic stroke(stroke group)with an incidence of 0. 48% ,19(0. 41% )patients had cerebral infarction, and 3(0. 07% )patients had transient ischemic attack(TIA). The rest 4 551 patients who had no acute ischemic stroke were enrolled as control group. Control group and stroke group were not significantly different in gender,age and the incidence rates of previous hypertension,diabetes,hyperlipemia,coronary heart disease,valvular heart disease and the times of surgery( P >0. 05);control group and stroke group were significantly different in the incidence rates of previous ischemic cerelral infarction and cardiac insufficiency,and atrial fibrillation type(P < 0. 05). Multivariate Logistic regression analysis showed that previous acute ischemic stroke〔 OR = 21. 342,95% CI(6. 549,69. 546)〕,insufficient cardiac function〔 OR = 8. 782,95% CI (3. 173,24. 308)〕and consistent atrial fibrillation〔 OR = 2. 990,95% CI(1. 137,7. 860)〕were independent risk factors for acute ischemic stroke in atrial fibrillation patients after RFCA during hospitalization( P < 0. 05). Compared with control group,stroke group had longer hospitalization time〔13(24) d vs. 5(2) d〕,higher case fatality rate〔9. 09% (2 / 22) vs. 0. 13% (6 / 4 551)〕,and lower ADL score at discharge〔(89. 8 ± 14. 6) vs. (99. 1 ± 4. 1)〕than control group(P <0. 05). Conclusion The overall incidence of acute ischemic stroke of patients with atrial fibrillation after RFCA is low,while acute ischemic stroke lengthens hospitalization time,increases case fatality rate in hospitals,and influences the activities of daily living of patients. Previous history of cerebral arterial thrombosis,insufficient cardiac function,and consistent atrial fibrillation are influencing factors for acute ischemic stroke during hospitalization after RFCA. The preoperative screening and the strict control of indications may help reduce the complication of acute ischemic stroke after RFCA.
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