[1]程若熙 龚俊荣 陈桂花 张俐.心房颤动导管消融术中ACT指导阶梯性抗凝方案与经验性抗凝方案的比较：一项倾向性评分匹配的观察性研究[J].心血管病学进展,2025,(11):1037.[doi:10.16806/j.cnki.issn.1004-3934.2025.11.016]
　CHENG Ruoxi,GONG Junrong,CHEN Guihua,et al.Comparison of ACT-Guided Stepwise Anticoagulation Regimen and Empirical Anticoagulation Regimen During Catheter Ablation for Atrial Fibrillation: A Propensity Score Matching Observational Study[J].Advances in Cardiovascular Diseases,2025,(11):1037.[doi:10.16806/j.cnki.issn.1004-3934.2025.11.016]
点击复制

心房颤动导管消融术中ACT指导阶梯性抗凝方案与经验性抗凝方案的比较：一项倾向性评分匹配的观察性研究()

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2025年11期
页码:
1037
栏目:
论著
出版日期:
2025-11-25

文章信息/Info

Title:
Comparison of ACT-Guided Stepwise Anticoagulation Regimen and Empirical Anticoagulation Regimen During Catheter Ablation for Atrial Fibrillation: A Propensity Score Matching Observational Study
作者:
程若熙1 龚俊荣 2 陈桂花 3 张俐 1
(1.南京医科大学附属苏州医院老年科,江苏 苏州 215000;2.南京医科大学附属苏州医院心血管内科,江苏 苏州 215000;3.南京医科大学附属第一人民医院心血管内科,江苏 南京 210000)
Author(s):
CHENG Ruoxi1; GONG Junrong2; CHEN Guihua3; ZHANG Li1
(1.Department of Geriatric Medicine,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215000,Jiangsu,China; 2.Department of Cardiovascular Medicine,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 21500 0,Jiangsu,China; 3.Department of Cardiovascular Medicine,The First Affiliated Hospit al of Nanjing Medical University,Nanjing 21 0000,Jiangsu,China)
关键词:
心房颤动; 导管消融术; 肝素; 激活全血凝血时间
Keywords:
Atrial fibrillation; Catheter ablation; Heparin; Activated coagulation time
DOI:
10.16806/j.cnki.issn.1004-3934.2025.11.016
摘要:
目的 本研究通过比较基于中国指南推荐的经验性抗凝方案与基于基础 激活全血凝血时间（ACT）值的阶梯性抗凝方案，旨在确定何种方案能更迅速、更安全、更有效地使ACT达到治疗目标。方法 本研究纳入来自南京医科大学附属第一人民医院心房颤动导管消融术的80例患者作为阶梯组，以及南京医科大学附属苏州医院的80例患者作为经验组。比较两组间基础ACT值、15 min时的ACT达标率、30 min时ACT达标率、60 min时ACT达标率以及术中肝素总用量情况。结果 阶梯组首次肝素推注后15 min时的ACT达标率（51.2%）在数值上高于经验组（45.0%），但差异无统计学意义（P=0.429）。阶梯组在房间隔穿刺后30 min时ACT达标率（75.0%）和60 min时ACT达标率（85.0%）均显著高于经验组（分别为56.3%和62.5%，P=0.013和P=0.001）。术中肝素总用量显著高于经验组（P=0.03）。术后观察72 h内的急性并发症，两组在出血方面比较未见明显统计学差异（P=0.468）。栓塞事件方面，经验组存在1例（1.3%）急性脑梗死，而阶梯组未观察到临床血栓栓塞事件。结论 基于基础ACT值的阶梯性抗凝方案较经验性抗凝方案更迅速、更有效地使ACT达到治疗目标，但阶梯性抗凝方案术中肝素总用量显著高于经验性抗凝方案，提示临床实践中需进行个体化风险效益评估。
Abstract:
Objective This study aims to determine which regimen can achieve the therapeutic target of activated coagulation time (ACT) more rapidly,safely,and effectively by comparing the empirical anticoagulation regimen recommended based on Chinese guidelines with the stepwise anticoagulation regimen based on baseline ACT values. Methods A total of 80 patients undergoing atrial fibrillation ablation at the First Affiliated Hospital of Nanjing Medical University were enrolled as the stepwise g roup, and 80 patients from The Affiliated Suzhou Hospital of Nanjing Medical University were included as the empirical group. Baseline ACT values,ACT target achievement rate within 15 minutes,ACT target achievement rate at 30 minutes ,ACT target achievement rate at 60 m inutes,and total intraoperative heparin dosage were compared between the two groups. Results The ACT target achievement rate within 15 minutes after the initial heparin bolus was numerically higher in the stepwise group(51.2%) compared to the empirical group(45.0%),but this difference was not statistically significant(P=0.429). The ACT target achievement rate(75.0%) and ACT target achievement rate(85.0%) of the stepwise group at 30 minutes and 60 minutes after atrial septal puncture were significantly higher than those of the empirical group(56.3% and 62.5%,respectively, P=0.013 and P=0.001). The total intraoperative heparin consumption in the stepwise group was significantly higher than that in the empirical group( P=0.03). Observation of acute complications within 72 hours after surgery showed no significant statistical difference in bleeding between the two groups(P=0.468). In terms of embolic events,there was 1 case(1.3%) of acute cerebral infarction in the empirical group,while no clinical thromboembolic events were observed in the stepwise group. Conclusion The stepwise anticoagulation regimen based on baseline ACT values is more rapid and effective in achieving ACT therapeutic target compared to empirical anticoagulation regimen. However,the intraoperative heparin consumption of the stepwise anticoagulation regimen is significantly higher than that of empirical anticoagulation regimen,indicating the need for individualized risk benefit assessment in clinical practice.

参考文献/References:

[1] Joglar JA,Chung MK,Armbruster AL,et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation,2024,149(1):e1-e156.

[2] Escudero-Martínez I,Morales-Caba L,Segura T. Atrial fibrillation and stroke:a review and new insights[J]. Trends Cardiovasc Med,2023,33(1):23- 29.

[3] Harada M,Motoike Y,Nomura Y,et al. Factors associated with silent cerebral events during atrial fibrillation ablation in patients on uninterrupted oral anticoagulation[J]. J Cardiovasc Electrophysiol,2020,31(11):2889-2897.

[4] 中华医学会心血管病学分会,中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南[J]. 中华心血管病杂志,2023,51(6):572-618.

[5] Bull BS,Huse WM,Brauer FS,et al. Heparin therapy during extracorporeal circulation.Ⅱ. The use of a dose-response curve to individualize heparin and protamine dosage[J]. J Thorac Cardiovasc Surg,1975,69(5):685-689.

[6] Cipolle RJ,Uden DL,Gruber SA,et al. Evaluation of a rapid monitoring system to study heparin pharmacokinetics and pharmacodynamics[J]. Pharmacotherapy,1990,10(6):367-372.

[7] 胡玉芳,王琳,王玉如,等. 心房颤动导管消融术中应用凝血酶原活化时间分段法指导首剂肝素用量的观察研究[J]. 齐鲁护理杂志,2016,22(4):121-122.

[8] Benali K,Khairy P,Hammache N,et al. Procedure-related complications of catheter ablation for atrial fibrillation[J]. J Am Coll Cardiol,2023,81(21):2089-2099.

[9] Mehran R,Rao SV,Bhatt DL,et al. Standardized bleeding definitions for cardiovascular clinical trials:a consensus report from the Bleeding Academic Research Consortium[J]. Circulation,2011,123(23):2736- 2747.

[10] Zhang RF,Ma CM,Wang N,et al. Appropriate intraprocedural initial heparin dosing in patients undergoing catheter ablation for atrial fibrillation receiving uninterrupted non-vitamin-K antagonist oral anticoagulant treatment[J]. BMC Cardiovasc Disord,2021,21(1):214.

[11] Tang S,Hu X,Bao W,et al. Development and validation of a nomogram model affecting the ACT targeting rate during radiofrequency ablation of atrial fibrillation in China[J]. Cardiovasc Drugs Ther,2024,38(6):1201-1214.

[12] Espay AJ,Hausdorff JM,Sánchez-Ferro ?,et al. A roadmap for implementation of patient-centered digital outcome measures in Parkinson’s disease obtained using mobile health technologies[J]. Mov Disord,2019,34(5):657-663.

[13] 高英英. 术前不同抗凝方案在房颤患者射频消融术治疗中对肝素用量的影响[J]. 康颐,2021,9(12):159.

[14] 施姣姣,颜清,杨沭,等. 华法林、达比加群酯和低分子肝素对心房颤动射频导管消融术中活化凝血时间达标情况及潜在血栓形成风险的影响[J]. 中国循环杂志,2022,37(5):465-471.

[15] Zhang J,Li S,Sang C,et al. Atrial fibrillation catheter ablation associated silent cerebral emboli:a narrative review[J]. Pacing Clin Electrophysiol,2023,46(9):1124- 1133.

相似文献/References:

[1]贺鹏康,周菁.心房颤动治疗新技术——冷冻球囊消融[J].心血管病学进展,2016,(1):1.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.001]
　HE Pengkang,ZHOU Jing.Cryoballoon Ablation, A Novel Technology for Atrial Fibrillation Treatment[J].Advances in Cardiovascular Diseases,2016,(11):1.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.001]
[2]都明辉,施海峰*,佟佳宾,等.心房颤动消融相关性无症状性脑缺血[J].心血管病学进展,2016,(1):3.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.002]
　DU Minghui,SHI Haifeng*,TONG Jiabin,et al.Silent Cerebral Ischemia Related to Atrial Fibrillation Ablation[J].Advances in Cardiovascular Diseases,2016,(11):3.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.002]
[3]郑环杰,综述,肖骅,等.心房颤动抗栓治疗研究进展[J].心血管病学进展,2016,(2):142.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.012]
　ZHENG Huanjie,XIAO Hua.Progress of Antithrombotic Therapy in Patients with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(11):142.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.012]
[4]张清,综述,罗素新,等.新型Xa 因子抑制剂———依度沙班在心房颤动患者抗凝治疗中的研究进展[J].心血管病学进展,2016,(2):151.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.014]
　ZHANG Qing,LUO Suxin,TANG Jiong.Novel Factor Xa Inhibitors—Edoxaban in Prevention of Stroke in Patients with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(11):151.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.014]
[5]胡红玲,综述,罗素新,等.预防非瓣膜性心房颤动性脑卒中的治疗新进展[J].心血管病学进展,2016,(3):250.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.009]
　HU Hongling,LUO Suxin.New Progress in the Treatment for Cerebral Apoplexy of Nonvalvular Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(11):250.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.009]
[6]王超,杨国澍,综述,等.关附甲素治疗心房颤动的研究进展[J].心血管病学进展,2016,(3):254.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.010]
　WANG Chao,YANG Guoshu,CAI Lin,et al.Research Progress of the Treatment of Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(11):254.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.010]
[7]徐小东,综述,杨东辉,等.决奈达隆治疗心房颤动的现状及展望[J].心血管病学进展,2016,(4):368.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.011]
　XU Xiaodong,YANG Donghui.Status and Prospect of Dronedarone in Treating Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2016,(11):368.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.011]
[8]张莎,储国俊,吴弘.经导管左心耳封堵术的临床应用进展[J].心血管病学进展,2015,(5):547.[doi:10.3969/j.issn.1004-3934.2015.05.006]
　ZHANG Sha,CHU Guojun,WU Hong.Clinial Application Advances in Left Atrial Appendage Closure[J].Advances in Cardiovascular Diseases,2015,(11):547.[doi:10.3969/j.issn.1004-3934.2015.05.006]
[9]汪俊,杨浩.心房颤动射频消融的术式演变[J].心血管病学进展,2015,(5):574.[doi:10.3969/j.issn.1004-3934.2015.05.013]
　WANG Jun,YANG Hao.Evolution of Radiofrequency Ablation of Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2015,(11):574.[doi:10.3969/j.issn.1004-3934.2015.05.013]
[10]赵璐,苏立.心房颤动与离子通道重构研究进展[J].心血管病学进展,2015,(5):580.[doi:10.3969/j.issn.1004-3934.2015.05.014]
　ZHAO Lu,SU Li.Research Progress of Atrial Fibrillation and Ion Channel Remodeling[J].Advances in Cardiovascular Diseases,2015,(11):580.[doi:10.3969/j.issn.1004-3934.2015.05.014]
[11]马丽 黄从新.心房颤动患者导管消融术后早期复发的机制及处理[J].心血管病学进展,2019,(5):762.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.024]
　MA LiHUANG Congxin.The Machanism and the Therapy of Early Recurrence after Catheter Ablation of Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2019,(11):762.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.024]
[12]解忠慧 崔凯军.心房颤动转子标测与消融的研究进展[J].心血管病学进展,2019,(8):1078.[doi:10.16806/j.cnki.issn.1004-3934.2019.08.002]
　XIE Zhonghui,CUI Kaijun.Rotors Ablation in Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2019,(11):1078.[doi:10.16806/j.cnki.issn.1004-3934.2019.08.002]
[13]赵海娟 李珂 赵耀 彭玉霞 黄松群 郭志福.成人先天性心脏病合并心房颤动的诊治进展[J].心血管病学进展,2023,(3):216.[doi:10.16806/j.cnki.issn.1004-3934.2023.03.006]
　ZHAO Haijuan,LI Ke,ZHAO Yao,et al.Atrial Fibrillation in Congenital Heart Disease[J].Advances in Cardiovascular Diseases,2023,(11):216.[doi:10.16806/j.cnki.issn.1004-3934.2023.03.006]

更新日期/Last Update: 2026-03-06