目的:探讨CHADS2评分对心房颤动(房颤)导管消融并发症的预测价值。方法:回顾性分析非瓣膜病房颤初次导管消融的患者共251例,计算入院时的CHADS2评分:心力衰竭(1分)、高血压(1分)、年龄≥75岁(1分)、糖尿病(1分)、既往脑卒中史(2分)。根据CHADS2评分,将患者分为CHADS2 0、1及≥2分3组,评价并发症发生率与CHADS2评分的关系。结果:251例房颤患者中,CHADS2=0的109例,CHADS2=1的75例,CHADS2≥2的67例。3组房颤病程、房颤类型、左房前后径、左室舒张末期内径、左室收缩末期内径、左室射血分数差异无统计学意义。发生并发症27例(10.7%)。并发症患者CHADS2评分显著高于无并发症患者[(1.4±1.3)∶(0.9±1.0),P〈0.05]。CHADS2=0、1及≥2组并发症发生率分别为8.3%、8.0%及17.9%,差异无统计学意义;3组出血和血栓并发症发生率随着CHADS2评分的增加而显著增加,分别为2.8%、6.7%及14.9%(P〈0.05)。在CHADS2的5个因素中,并发症的发生率在有和无糖尿病组[(32.1%∶8.1%,P〈0.001)]以及有和无脑卒中病史组[(29.4%∶9.4%,P=0.010)]之间有统计学差异。结论:CHADS2≥2时,房颤导管消融血栓和出血并发症显著增加。
Objective:To explore if CHADS2 score could predict complications in catheter ablation of atrial fi- brillation (Af). Method: All 251 patients undergoing catheter ablation of Af were enrolled. CHADS2 score was calculated as follows., two points were assigned for history of stroke or transient ischemic attack and 1 point each was assigned for age ≥75, history of hypertension, diabetes, recent cardiac failure. Result: Of the 251 patients, 109 patients had CHADS2 =0, 75 patients had CHADS2 = 1, 67 patients had CHADS2≥ 2. There were no differences of Af duration, Af typet, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-aystolic diameter and ejection fraiction among the three groups. There were 27 patients suffered complications (10.7%). CHADS2 score was significantly higher in the patients with complications [(1.4± 1.3) vs (0. 9± 1.0),P〈0.05] than those without. The incidence rate were 8.3%, 8.0%, 17.9% among the groups with C HADS2= 0,1,≥2, respectively (P = 0. 087). The thrombotic and bleeding complications was significantly in- creased with CHADS2 score with the complication rate 2.8%, 6.7 %, 14.9 % among the three groups(P〈0. 05). The complication rate was significantly higher in the patients with diabetes (32.1% VS. 8.1% ,P〈0. 001) and previous stroke (29.4% VS 9.4% % ,P=0. 010) than those without. Conclusion: CHADS2 score have an important role in the prediction of complication in catheter ablation of Af.