冷冻球囊消融与电复律治疗初发持续性心房颤动疗效及安全性比较

doi:10.16138/j.1673-6087.2026.03.02

内科理论与实践 ›› 2026, Vol. 21 ›› Issue (03): 211-216.doi: 10.16138/j.1673-6087.2026.03.02

冷冻球囊消融与电复律治疗初发持续性心房颤动疗效及安全性比较

卫越(), 包阳扬, 罗庆志, 谢运, 林长坚, 张凝, 金奇, 凌天佑(), 吴立群()

上海交通大学医学院附属瑞金医院心内科，上海　200025

收稿日期:2026-03-16 修回日期:2026-04-07 接受日期:2026-06-08 出版日期:2026-06-25 发布日期:2026-08-19
通讯作者: 凌天佑 E-mail：lingtianyouyou@163.com;吴立群 E-mail：wuliqun89@hotmail.com
作者简介:作者贡献/Authors’ Contributions卫越负责收集数据、撰写论文；包阳扬、罗庆志、谢运、林长坚负责分析审核数据；张凝、金奇负责论文撰写指导及修改；凌天佑、吴立群负责论文审核。
基金资助:
上海市卫生健康委员会科研项目(20224Y0028)

Comparison of efficacy and safety between cryoballoon ablation and electrical cardioversion for treatment of first-episode persistent atrial fibrillation

WEI Yue(), BAO Yangyang, LUO Qingzhi, XIE Yun, LIN Changjian, ZHANG Ning, JIN Qi, LING Tianyou(), WU Liqun()

Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2026-03-16 Revised:2026-04-07 Accepted:2026-06-08 Online:2026-06-25 Published:2026-08-19

摘要/Abstract

摘要：

目的：比较冷冻球囊消融与电复律治疗初发、未经治疗的持续性心房颤动（房颤）患者的疗效与安全性。方法：纳入我院冷冻球囊消融及电复律治疗的初发持续性房颤患者，并应用倾向评分匹配平衡基线特征，最终纳入房颤持续时间<1年的患者70例，其中冷冻组35例，电复律组35例。主要有效性终点为操作后1年无房颤复发率，安全性终点为严重并发症发生率。结果：冷冻组的1年无复发率显著高于电复律组（76.6%比45.0%，P<0.05），而2组治疗后卒中、心包填塞等严重并发症发生率差异无统计学意义。左心房内径增大为冷冻球囊消融操作后复发的独立危险因素（风险比=1.319，P=0.046），而房颤病程是电复律后复发的独立危险因素（风险比=1.131，P=0.037）。结论：对于初发持续性房颤患者，冷冻球囊消融在维持窦性心律方面优于电复律，且安全性良好。左心房内径与房颤病程分别是预测两种治疗方式后复发的重要因素，有助于指导个体化临床决策。

关键词: 心房颤动, 电复律, 冷冻球囊消融, 倾向评分匹配

Abstract:

Objective To compare the efficacy and safety of cryoballoon ablation versus electrical cardioversion in patients with first-episode, untreated persistent atrial fibrillation. Methods Patients with first-episode persistent atrial fibrillation who received cryoballoon ablation or electrical cardioversion in our hospital were enrolled. Propensity score matching was applied to balance baseline characteristics, and a total of 70 patients with atrial fibrillation duration <1 year were finally included, with 35 in the cryoballoon group and 35 in the cardioversion group. The primary efficacy endpoint was the freedom from atrial fibrillation recurrence at 1 year post-procedure, and the safety endpoint was the incidence of major complications. Results The 1-year freedom from recurrence rate was significantly higher in the cryoballoon group than in the cardioversion group (76.6% vs. 45.0%, P<0.05). No significant difference was observed between the 2 groups in the incidence of severe complications such as stroke or cardiac tamponade. Left atrial diameter was identified as an independent risk factor for recurrence after cryoballoon ablation (hazard ratio=1.319, P=0.046), whereas atrial fibrillation duration was an independent risk factor for recurrence after cardioversion (hazard ratio=1.131, P=0.037).Conclusions For patients with first-episode persistent atrial fibrillation, cryoballoon ablation is superior to electrical cardioversion in maintaining sinus rhythm, with a favorable safety profile. Left atrial diameter and atrial fibrillation duration are important predictors of recurrence after each treatment modality, which may help guide individualized clinical decision-making.

Key words: atrial fibrillation, electrical cardioversion, cryoballoon ablation, propensity score matching

中图分类号:

R541.7

卫越, 包阳扬, 罗庆志, 谢运, 林长坚, 张凝, 金奇, 凌天佑, 吴立群. 冷冻球囊消融与电复律治疗初发持续性心房颤动疗效及安全性比较[J]. 内科理论与实践, 2026, 21(03): 211-216.

WEI Yue, BAO Yangyang, LUO Qingzhi, XIE Yun, LIN Changjian, ZHANG Ning, JIN Qi, LING Tianyou, WU Liqun. Comparison of efficacy and safety between cryoballoon ablation and electrical cardioversion for treatment of first-episode persistent atrial fibrillation[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(03): 211-216.

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参考文献 16

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指标	冷冻组(n=35)	电复律组(n=35)	t /χ²	P
年龄（岁）	63.4±8.6	63.1±9.1	0.14	0.89
男性	23(65.7%)	23(65.7%)	0	0.73
BMI (kg/m²)	24.4±3.0	24.3±3.4	0.12	0.91
房颤病程（月）	7.1±4.2	6.7±4.4	0.42	0.68
高血压[n（%）]	20（57.1）	17（48.6）	0.52	0.47
糖尿病[n（%）]	4（11.4）	3（8.6）	0.16	0.69
冠心病[n（%）]	4（11.4）	3（8.6）	0.16	0.69
心功能不全[n（%）]	2（5.7）	1（2.9）	0.35	0.56
脑卒中[n（%）]	0（0）	1（2.9）	1.01	0.31
左心房内径（mm）	40.1±2.7	40.7±2.7	0.91	0.37
左心室舒张末期内径（mm）	48.4±3.9	48.0±4.1	0.85	0.40
左心室射血分数（%）	65.9±5.4	65.8±4.4	1.61	0.93

变量	冷冻组			电复律组
变量	HR	95%CI	P	HR	95%CI	P
年龄	0.974	0.892~1.065	0.568	1.017	0.949~1.09	0.630
性别（男性）	0.791	0.189~3.316	0.748	1.238	0.436~3.518	0.688
BMI (kg/m²)	1.050	0.774~1.425	0.754	1.079	0.91~1.278	0.383
病程（月）	1.093	0.914~1.306	0.331	1.131	1.007~1.269	0.037
高血压	1.064	0.266~4.261	0.930	2.172	0.798~5.913	0.129
糖尿病	1.077	0.132~8.757	0.945	1.751	0.398~7.711	0.459
冠心病	1.213	0.149~9.868	0.857	0.726	0.096~5.49	0.756
心功能不全	3.143	0.383~25.781	0.286	1.354	0.179~10.25	0.769
左心房内径	1.414	1.052~1.899	0.022	1.191	1.001~1.417	0.048

变量	冷冻组			电复律组
变量	HR	95%CI	P	HR	95%CI	P
年龄	0.969	0.876~1.073	0.548	0.981	0.908~1.060	0.629
房颤病程（月）	0.939	0.771~1.143	0.528	1.131	1.007~1.269	0.037
左心房内径（mm）	1.319	1.005~1.732	0.046	1.220	0.989~1.503	0.063

冷冻球囊消融与电复律治疗初发持续性心房颤动疗效及安全性比较

Comparison of efficacy and safety between cryoballoon ablation and electrical cardioversion for treatment of first-episode persistent atrial fibrillation

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