不同抗凝策略对心房颤动导管消融心脏压塞并发症处理的影响

摘要

Objective To observe the management and outcome of the cardiac tamponade patients during the ablation procedure using two different anticoagulation strategies. Methods All the patients developed tamponade during the ablation procedure were enrolled from January 2007 to December 2013 in our center. In group 1, warfarin was discontinued 3 to 5 days before the procedure and low molecular weight heparin (LMWH) was administered subcutaneously until ablation procedure day. In group 2, warfarin was not discontinued and the international normalized ratio INR was to maintained between 2 and 3. Results There were 27 patients (0.6%) developed cardiac tamponade out of a total 4487 patients received ablation in our center. The baseline clinical characteristics including age, left atrium, the heparin dose and ACT during the procedure had no signiifcant difference between the groups, except that the INR was higher in the group 2 (0.9±0.1 vs. 2.3±0.5, P<0.001). There was no signiifcant difference in the amount of pericardiac drainage between the two groups (365±222 ml vs. 506±300 ml, P=0.137). Two patients in group 1 patient (11.1%) and 1 in group 2 (11.1%) needed emergency surgical repair (P>0.999). The median hospital day was similar in the 2 groups [(9.6±3.3) d vs. (12.1±4.5) d, P=0.167]. There were no other serious complications and no hospital death. Conclusions Non-discontinuation of warfarin during peri-procedural catheter ablation of AF is not signiifcantly different to bridging with LMWH in the management and outcome of acute cardiac tamponade.%目的：观察围术期不同抗凝策略对心房颤动（房颤）导管消融心脏压塞并发症处理的影响。方法连续入选2007年1月至2013年12月4487例导管消融术中发生心脏压塞并发症的患者27例，发生率0.6%。按围术期抗凝策略分组：第1组患者术前停用华法林3～5 d，以低分子肝素皮下注射桥接过渡；第2组患者围术期不中断华法林抗凝，国际标准化比值（INR）控制在1.8～2.5。对比两组患者心脏压塞并发症的临床处理及转归。结果共27例急性心脏压塞的患者入选，其中第1组18例，第2组9例。除术前INR（0.9±0.1比2.3±0.5，P＜0.001）之外，两组基线资料包括年龄、左心房前后径、血小板计数、术中肝素用量、术中活化凝血时间（ACT）等均差异无统计学意义。所有患者均在剑突下穿刺心包成功并置入6 F猪尾管引流，两组心包积液引流量分别为（365±222）ml和（506±300）ml，P=0.137；分别有10例（55.6%）和7例（77.8%）应用了自体血回输技术，P=0.406；分别有2例（11.1%）和1例（11.1%）心包引流无效进行急诊外科开胸，P＞0.999；两组患者住院时间分别为（9.6±3.3）d和（12.1±4.5）d， P=0.167。未发生其他严重并发症。结论房颤导管消融围术期不中断华法林抗凝对急性心脏压塞并发症的处理及预后无明显不良影响。