Research Progress of Perioperative Symptoms and Management Strategies in Patients Undergoing Catheter Ablation for Atrial Fibrillation

doi:10.12114/j.issn.1007-9572.2024.0337

Abstract

Abstract:

The burden of atrial fibrillation (AF) in China is increasing, and catheter ablation has become a first-line treatment. The perioperative symptom clusters of AF patients undergoing catheter ablation are complex and diverse, closely related to patients´ quality of life, disease prognosis, and healthcare resource utilization, and therefore, warrant significant attention. This paper systematically reviews the research related to the perioperative symptom clusters of AF patients undergoing catheter ablation. It introduces the types and current status of these symptom clusters, summarizes the influencing factors of perioperative symptom clusters, organizes the assessment tools for AF symptom clusters, and finally elucidates the management strategies for perioperative symptom clusters in AF patients. The goal is to provide insights for developing innovative comprehensive management models for perioperative symptom clusters in AF patients.

Key words: Atrial fibrillation, Catheter ablation, Perioperative, Symptom clusters, Symptom management, Review

摘要：

我国心房颤动疾病负担日益沉重，导管消融已成为一线治疗手段。心房颤动患者导管消融围术期症状群复杂多样，与患者生活质量、疾病预后以及医疗资源利用紧密相关，亟需引起关注。本文对心房颤动患者导管消融围术期症状群相关研究进行系统梳理，介绍了围术期症状群类型及发生现状，总结了心房颤动围术期症状群影响因素，整理了心房颤动围术期症状群评估工具，最后阐述了心房颤动患者围术期症状群管理策略，以期为创新心房颤动患者围术期症状群综合管理新模式提供借鉴。

关键词: 心房颤动, 导管消融术, 围术期, 症状群, 症状管理, 综述

BAO Zhipeng,LI Yunxia,WANG Jie, et al. Research Progress of Perioperative Symptoms and Management Strategies in Patients Undergoing Catheter Ablation for Atrial Fibrillation[J]. Chinese General Practice, 2025, 28(12): 1479-1485. DOI: 10.12114/j.issn.1007-9572.2024.0337.
鲍志鹏,李芸霞,王洁等. 心房颤动患者导管消融围术期症状群及管理策略[J]. 中国全科医学, 2025, 28(12): 1479-1485. DOI: 10.12114/j.issn.1007-9572.2024.0337.

References 64

[1]	JOGLAR J A，CHUNG M K，ARMBRUSTER A L，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）：e1-156. DOI：10.1161/CIR.0000000000001193.
[2]	SHI S B，TANG Y H，ZHAO Q Y，et al. Prevalence and risk of atrial fibrillation in China：a national cross-sectional epidemiological study[J]. Lancet Reg Health West Pac，2022，23：100439. DOI：10.1016/j.lanwpc.2022.100439.
[3]	周利慧，彭琴，王媛，等. 中国居民1993—2017年心房颤动发病及死亡趋势年龄–时期–队列模型分析[J]. 中国公共卫生，2021，37（11）：1672-1676. DOI：10.11847/zgggws1131433.
[4]	SCHWENNESEN H T，ANDRADE J G，WOOD K A，et al. Ablation to reduce atrial fibrillation burden and improve outcomes：JACC review topic of the week[J]. J Am Coll Cardiol，2023，82（10）：1039-1050. DOI：10.1016/j.jacc.2023.06.029.
[5]	TZEIS S，GERSTENFELD E P，KALMAN J，et al. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation[J]. Europace，2024，26（4）：euae043. DOI：10.1093/europace/euae043.
[6]	FREEMAN J V，WANG Y，AKAR J，et al. National trends in atrial fibrillation hospitalization，readmission，and mortality for medicare beneficiaries，1999-2013[J]. Circulation，2017，135（13）：1227-1239. DOI：10.1161/CIRCULATIONAHA.116.022388.
[7]	中华医学会心电生理和起搏分会，中国医师协会心律学专业委员会，中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动：目前的认识和治疗建议（2021）[J]. 中华心律失常学杂志，2022，26（1）：15-88. DOI：10.3760/cma.j.cn113859-20211224-00264.
[8]	STREUR M，RATCLIFFE S J，BALL J，et al. Symptom clusters in adults with chronic atrial fibrillation[J]. J Cardiovasc Nurs，2017，32（3）：296-303. DOI：10.1097/JCN.0000000000000344.
[9]	葛红玥，林梅，许志英. 心房颤动患者症状群及其影响因素研究[J]. 中华护理杂志，2020，55（8）：1189-1196. DOI：10.3761/j.issn.0254-1769.2020.08.015.
[10]	HOBENSACK M，ZHAO Y H，SCHARP D，et al. Characterising symptom clusters in patients with atrial fibrillation undergoing catheter ablation[J]. Open Heart，2023，10（2）：e002385. DOI：10.1136/openhrt-2023-002385.
[11]	SEARS S F，ANTHONY S，HARRELL R，et al. Managing atrial fibrillation：the intersection of cardiology，health psychology，and the patient experience[J]. Health Psychol，2022，41（10）：792-802. DOI：10.1037/hea0001135.
[12]	李媛媛，袁丽，彭艳利. 行射频消融术的心房颤动患者术前不良情绪现状及影响因素分析 [J]. 中西医结合护理，2023，9（2）：142-144. DOI：10.11997/nitcwm.202302042.
[13]	KOLECK T A，MITHA S A，BIVIANO A，et al. Exploring depressive symptoms and anxiety among patients with atrial fibrillation and/or flutter at the time of cardioversion or ablation[J]. J Cardiovasc Nurs，2021，36（5）：470-481. DOI：10.1097/JCN.0000000000000723.
[14]	AL-KAISEY A M，PARAMESWARAN R，BRYANT C，et al. Atrial fibrillation catheter ablation vs medical therapy and psychological distress：a randomized clinical trial[J]. JAMA，2023，330（10）：925-933. DOI：10.1001/jama.2023.14685.
[15]	DU M L，CHENG T N，YE Y T，et al. Prevalence and risk factors of postprocedure depression in patients with atrial fibrillation after radiofrequency ablation[J]. Cardiol Res Pract，2023，2023：4635336. DOI：10.1155/2023/4635336.
[16]	RISOM S S，FEVEJLE CROMHOUT P，OVERGAARD D，et al. Effect of rehabilitation on sleep quality after ablation for atrial fibrillation：data from a randomized trial[J]. J Cardiovasc Nurs，2018，33（3）：261-268. DOI：10.1097/JCN.0000000000000476.
[17]	DU H，YANG L，HU Z，et al. Anxiety is associated with higher recurrence of atrial fibrillation after catheter ablation：a meta-analysis[J]. Clin Cardiol，2022，45（3）：243-250. DOI：10.1002/clc.23753.
[18]	STREUR M，RATCLIFFE S J，CALLANS D，et al. Atrial fibrillation symptom clusters and associated clinical characteristics and outcomes：a cross-sectional secondary data analysis[J]. Eur J Cardiovasc Nurs，2018，17（8）：707-716. DOI：10.1177/1474515118778445.
[19]	CHUANG H J，LIN L C，YU A L，et al. Predicting impaired cardiopulmonary exercise capacity in patients with atrial fibrillation using a simple echocardiographic marker[J]. Heart Rhythm，2024，21（9）：1493-1499. DOI：10.1016/j.hrthm.2024.04.048.
[20]	鲍志鹏，孙国珍，商淑华，等. 心房颤动患者射频消融术后运动耐力现状及影响因素分析[J]. 中国全科医学，2020，23（32）：4080-4084，4103. DOI：10.12114/j.issn.1007-9572.2020.00.133.
[21]	MUJOVIĆ N M，MARINKOVIĆ M M，NEDELJKOVIĆ I，et al. Improvement of maximal exercise performance after catheter-ablation of atrial fibrillation and its prognostic significance for long-term rhythm outcome[J]. J Am Heart Assoc，2021，10（3）：e017445. DOI：10.1161/JAHA.120.017445.
[22]	WOOD K A，BARNES A H，JENNINGS B M. Trajectories of recovery after atrial fibrillation ablation[J]. West J Nurs Res，2022，44（7）：653-661. DOI：10.1177/01939459211012087.
[23]	RASMUSSEN P V，DALGAARD F，GISLASON G H，et al. Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation[J]. Eur Heart J，2022，43（7）：e38-44. DOI：10.1093/eurheartj/ehz964.
[24]	MADHAVAN M，GRAFF-RADFORD J，PICCINI J P，et al. Cognitive dysfunction in atrial fibrillation[J]. Nat Rev Cardiol，2018，15（12）：744-756. DOI：10.1038/s41569-018-0075-z.
[25]	刘冬霞，张厚贞.高龄非瓣膜性房颤患者应用利伐沙班抗凝防治轻中度认知功能障碍的护理策略[J].中国全科医学，2021，24（S1）：212-216.
[26]	BAMGBADE B A，SANGHAI S R，MCMANUS D D，et al. Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation：the systematic assessment of geriatric elements in atrial fibrillation （SAGE-AF） cohort study[J]. Arch Gerontol Geriatr，2020，90：104117. DOI：10.1016/j.archger.2020.104117.
[27]	AL-KAISEY A M，PARAMESWARAN R，BRYANT C，et al. Impact of catheter ablation on cognitive function in atrial fibrillation：a randomized control trial[J]. JACC Clin Electrophysiol，2023，9（7 Pt 2）：1024-1034. DOI：10.1016/j.jacep.2023.02.020.
[28]	PETERSEN M，CHEVALIER C，NAEGELE F L，et al. Mapping the interplay of atrial fibrillation，brain structure，and cognitive dysfunction[J]. Alzheimers Dement，2024，20（7）：4512-4526. DOI：10.1002/alz.13870.
[29]	HASHIMOTO N，ARIMOTO T，KOYAMA K，et al. Improved cerebral blood flow and hippocampal blood flow in stroke-free patients after catheter ablation of atrial fibrillation[J]. J Cardiovasc Electrophysiol，2023，34（10）：2055-2064. DOI：10.1111/jce.16054.
[30]	ZHANG J，XIA S J，DU X，et al. Incidence and risk factors of post-operative cognitive decline after ablation for atrial fibrillation[J]. BMC Cardiovasc Disord，2021，21（1）：341. DOI：10.1186/s12872-021-02139-7.
[31]	BRANT J M，BECK S，MIASKOWSKI C. Building dynamic models and theories to advance the science of symptom management research[J]. J Adv Nurs，2010，66（1）：228-240. DOI：10.1111/j.1365-2648.2009.05179.x.
[32]	ESSIEN U R，KORNEJ J，JOHNSON A E，et al. Social determinants of atrial fibrillation[J]. Nat Rev Cardiol，2021，18（11）：763-773. DOI：10.1038/s41569-021-00561-0.
[33]	王可妍，李益萍，王肖龙. 心房颤动患者合并焦虑、抑郁的研究进展[J]. 中国医药导报，2020，17（31）：70-73.
[34]	WALTERS T E，WICK K，TAN G，et al. Symptom severity and quality of life in patients with atrial fibrillation：psychological function outweighs clinical predictors[J]. Int J Cardiol，2019，279：84-89. DOI：10.1016/j.ijcard.2018.10.101.
[35]	SADLONOVA M，SENGES J，NAGEL J，et al. Symptom severity and health-related quality of life in patients with atrial fibrillation：findings from the observational ARENA study[J]. J Clin Med，2022，11（4）：1140. DOI：10.3390/jcm11041140.
[36]	TABAJA C，YOUNIS A，SANTAGELI P，et al. Impact of obesity on catheter ablation of atrial fibrillation：patient characteristics，procedural complications，outcomes，and quality of life[J]. J Cardiovasc Electrophysiol，2023，34（8）：1648-1657. DOI：10.1111/jce.15987.
[37]	SŁAWUTA A，JACEK P，MAZUR G，et al. Quality of life and frailty syndrome in patients with atrial fibrillation[J]. Clin Interv Aging，2020，15：783-795. DOI：10.2147/CIA.S248170.
[38]	廖婷婷，李高叶，阮芳，等. 心房颤动患者认知功能障碍危险因素的研究进展[J]. 中国护理管理，2021，21（10）：1579-1583. DOI：10.3969/j.issn.1672-1756.2021.10.029.
[39]	SÄRNHOLM J，SKÚLADÓTTIR H，RÜCK C，et al. Cognitive behavioral therapy improves quality of life in patients with symptomatic paroxysmal atrial fibrillation[J]. J Am Coll Cardiol，2023，82（1）：46-56. DOI：10.1016/j.jacc.2023.04.044.
[40]	HASEBE H，SHINBA T. Decreased anxiety after catheter ablation for paroxysmal atrial fibrillation is associated with augmented parasympathetic reactivity to stress[J]. Heart Rhythm O2，2020，1（3）：189-199. DOI：10.1016/j.hroo.2020.05.008.
[41]	林海蓉，杨慧锋，许志英，等. 心房颤动患者症状负担及其影响因素分析[J]. 护理学杂志，2022，37（21）：1-5. DOI：10.3870/j.issn.1001-4152.2022.21.001.
[42]	TAYLOR E C，O´NEILL M，HUGHES L D，et al. Atrial fibrillation，quality of life and distress：a cluster analysis of cognitive and behavioural responses[J]. Qual Life Res，2022，31（5）：1415-1425. DOI：10.1007/s11136-021-03006-w.
[43]	DELLA ROCCA D G，MAGNOCAVALLO M，NATALE V N，et al. Clinical presentation，diagnosis，and treatment of atrioesophageal fistula resulting from atrial fibrillation ablation[J]. J Cardiovasc Electrophysiol，2021，32（9）：2441-2450. DOI：10.1111/jce.15168.
[44]	TEPPO K，JAAKKOLA J，BIANCARI F，et al. Mental health conditions and bleeding events in patients with incident atrial fibrillation：a Finnish nationwide cohort study[J]. Gen Hosp Psychiatry，2022，78：117-122. DOI：10.1016/j.genhosppsych.2022.08.003.
[45]	LADWIG K H，GOETTE A，ATASOY S，et al. Psychological aspects of atrial fibrillation：a systematic narrative review：impact on incidence，cognition，prognosis，and symptom perception[J]. Curr Cardiol Rep，2020，22（11）：137. DOI：10.1007/s11886-020-01396-w.
[46]	BUCKLEY B J R，RISOM S S，BOIDIN M，et al. Atrial fibrillation specific exercise rehabilitation：are we there yet?[J]. J Pers Med，2022，12（4）：610. DOI：10.3390/jpm12040610.
[47]	SEGAN L，PRABHU S，KALMAN J M，et al. Atrial fibrillation and stress：a 2-way street?[J]. JACC Clin Electrophysiol，2022，8（8）：1051-1059. DOI：10.1016/j.jacep.2021.12.008.
[48]	王洁，孙国珍，鲍志鹏，等. 心房颤动患者自我报告症状评估工具的研究进展[J]. 中华心血管病杂志，2022，50（2）：195-199. DOI：10.3760/cma.j.cn112148-20211206-01052.
[49]	李颖怡，王群山. 心房颤动患者的生活质量评估和最新症状分级方法[J]. 中国循环杂志，2015，30（7）：708-710. DOI：10.3969/j.issn.1000-3614.2015.07.022.
[50]	ARBELO E，AKTAA S，BOLLMANN A，et al. Quality indicators for the care and outcomes of adults with atrial fibrillation[J]. Europace，2021，23（4）：494-495. DOI：10.1093/europace/euaa253.
[51]	康洪玲，闫继英，张春燕. 心房颤动患者症状群与生活质量的相关性研究[J]. 北京医学，2022，44（1）：5-9. DOI：10.15932/j.0253-9713.2022.01.002.
[52]	STREUR M M，RATCLIFFE S J，CALLANS D J，et al. Atrial fibrillation symptom profiles associated with healthcare utilization：a latent class regression analysis[J]. Pacing Clin Electrophysiol，2018，41（7）：741-749. DOI：10.1111/pace.13356.
[53]	VAN DER TUIN S，BALAFAS S E，OLDEHINKEL A J，et al. Dynamic symptom networks across different at-risk stages for psychosis：an individual and transdiagnostic perspective[J]. Schizophr Res，2022，239：95-102. DOI：10.1016/j.schres.2021.11.018.
[54]	VAN GELDER I C，RIENSTRA M，BUNTING K V，et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery（EACTS）[J]. Eur Heart J，2024：ehae176. DOI：10.1093/eurheartj/ehae176.
[55]	MARK D B，ANSTROM K J，SHENG S B，et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation：the CABANA randomized clinical trial[J]. JAMA，2019，321（13）：1275-1285. DOI：10.1001/jama.2019.0692.
[56]	ELLIOTT A D，VERDICCHIO C V，MAHAJAN R，et al. An exercise and physical activity program in patients with atrial fibrillation：the ACTIVE-AF randomized controlled trial[J]. JACC Clin Electrophysiol，2023，9（4）：455-465. DOI：10.1016/j.jacep.2022.12.002.
[57]	BORLAND M，BERGFELDT L，CIDER Å，et al. Effects of 3 months of detraining following cardiac rehabilitation in patients with atrial fibrillation[J]. Eur Rev Aging Phys Act，2022，19（1）：14. DOI：10.1186/s11556-022-00293-1.
[58]	ZHENG M J，XIE Z J，SHI X X，et al. The effects of cognitive behavioral therapy on health-related quality of life，anxiety，depression，illness perception，and in atrial fibrillation patients：a six-month longitudinal study[J]. BMC Psychol，2023，11（1）：431. DOI：10.1186/s40359-023-01457-z.
[59]	中国互联网络信息中心. 第54次《中国互联网络发展状况统计报告》[EB/OL].（2024-08-29）[2024-09-06].
[60]	余超，周伟，王涛，等. 可穿戴设备支持心房颤动人群筛查与管理研究进展[J]. 中国全科医学，2023，26（1）：113-117. DOI：10.12114/j.issn.1007-9572.2022.0449.
[61]	CHANG S L，KUO M J，LIN Y J，et al. Virtual reality-based preprocedural education increases preparedness and satisfaction of patients about the catheter ablation of atrial fibrillation[J]. J Chin Med Assoc，2021，84（7）：690-697. DOI：10.1097/JCMA.0000000000000555.
[62]	HE Y，TANG Z J，SUN G Z，et al. Effectiveness of a mindfulness meditation app based on an electroencephalography-based brain-computer interface in radiofrequency catheter ablation for patients with atrial fibrillation：pilot randomized controlled trial[J]. JMIR Mhealth Uhealth，2023，11：e44855. DOI：10.2196/44855.
[63]	鲍志鹏，孙国珍，杨刚，等. 互联网+居家运动康复对心房颤动患者射频消融术后运动耐力及运动依从性的影响[J]. 中国康复医学杂志，2021，36（1）：82-85. DOI：10.3969/j.issn.1001-1242.2021.01.015.
[64]	GUO Y T，ROMITI G F，CORICA B，et al. Mobile health-technology integrated care in atrial fibrillation patients with heart failure：a report from the mAFA-Ⅱ randomized clinical trial[J]. Eur J Intern Med，2023，107：46-51. DOI：10.1016/j.ejim.2022.11.002.