CARTO系统指导下153例房颤导管消融术短期疗效及安全性分析  

Short-term efficacy and safety of CARTO-guided ablation in treatment of 153 patients with atrial fibrillation

作　　者：刘广安[1] 刘峰[1] 陈润祥[1] 吴晶晶[1] 游斌权[1] 程海[1] 王炳银[1] 

机构地区：[1]上海交通大学医学院苏州九龙医院,江苏苏州215021

出　　处：《实用临床医药杂志》2015年第9期12-17,共6页Journal of Clinical Medicine in Practice

摘　　要：目的以Carto三维标测系统指导下环肺静脉电隔离为基础联合其他消融术式观察并分析术后90 d的成功率、复发率、安全性及复发相关危险因素。方法选自上海交通大学医学院苏州九龙医院心内科2006—2014年153例房颤导管消融术患者,依据术前诊断分为阵发房颤组(98例)和持续房颤组(55例),所有患者均完成环肺静脉电隔离并达到完全阻滞,必要时联合其他消融术式,连续跟踪随访90天,以心电图(ECG)、经胸心脏超声(TTE)及动态心电图(Holter)等检查结果分析成功率、复发率、安全性及复发相关危险因素。结果 153例患者术后即刻成功率100%,术后90天维持窦性节律115例,总体成功率75.2%,复发率24.8%。其中阵发房颤组98例术后90天仍维持窦律者77例,成功率达78.6%,复发率21.4%;持续房颤组有55例,术后90天仍为窦律者38例,成功率为69.1%,复发率30.9%。阵发房颤组成功率高于持续房颤组,具有统计学差异(P<0.05)。阵发房颤组TTE提示左心房内径(LAD)无明显变化(P>0.05),持续房颤组LAD有减小趋势,无统计学差异(P>0.05),其中维持窦律者术前LAD(44.27±3.49)mm比术后LAD(40.16±3.05)mm有所减小,具统计学差异(P<0.05)。两组患者左室射血分数在手术前后均无明显变化。应用Cox单因素回归分析显示年龄、持续性房颤、术前LAD增大是术后房颤复发的危险因素。总体并发症发生率为5.9%,其中严重并发症(心包压塞)1例,发生率为0.7%,其他并发症(如穿刺点血肿、围术期感染)共8例(5.2%),无心房食管瘘及死亡。结论 Carto指导下房颤导管消融术短期疗效明确且安全性良好。Objective To observe and analyze the efficacy and safety of the procedures dominated by circumferential pulmonary vein ablation（CPVI） combined with other catheter ablation approaches for 1 5 3 cases with atrial fibrillation（AF） who guided by CARTO system,meanwhile to analyze the risk factors of recurrence. Methods A total of 153 AF patients admitted in our department from 2006 to 2014 were recruited in this study. All the patients were divided into paroxysmal AF group and pesistant AF group on the basis of preoperative diagnosis. Each patient achieved CPVI but combined other ablation approaches necessarily requesting the complete isolation.During a continuous follow-up by 90 days,the rate of success and recurrence,the incidence of complications and recurrence-related risk factors were analyzed by estimated with Electrocardiogram（ECG）,transthoracic echocardiography（TTE） and Holter. Results The success rate of 153 patients achieved 100% after the procedure immediately,115 patients remained sinus rythem（RM） 90 days after ablation. Total success rate was 75. 2% and recurrence rate was 24. 8%. Furthermore in paroxysmal AF group, 77 cases remained RM indicated 78. 6% for success rate and the recurrence rate was 2 1. 4 %,but the number of patients who remained RM was only 3 8 in persistent AF group which success rate was 69. 1% and reccurence rate was 30. 9%. The success rate in paroxysmal AF group was significantly higher than the other group（P〈 0. 05）. By follow-up90 days the left atrial diameter（LAD） did not change in paroxysmal AF group by TEE examination（P〉 0. 05）. Also,no significant change in LAD was observed in persistent AF group（P〉 0. 05）but trended smaller. However,the mean LAD before and after treatment in persistent AF group who maintained RM was（44. 27 ± 3. 49） mm and（40. 16 ± 3. 05） mm（P〈 0. 05）. The left ventricular ejection fraction in the both groups indicated no significant change pre and post operation. Age,persistent AF and LAD extended were

关 键 词：心房颤动 导管消融术 成功率 复发 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]