冷冻球囊导管消融治疗心房颤动  

Cryoballoon ablation for atrial fibrillation

作　　者：周公哺[1] 郭晓刚[1] 刘旭[1] 杨建都 孙奇[1] 马坚[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2015年第3期174-178,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨冷冻球囊导管消融治疗心房颤动（房颤）的方法、策略和短期随访结果。方法2013年11月至2015年1月连续人选就诊于阜外医院接受冷冻球囊导管消融术的房颤患者共70例。在冷冻球囊导管消融过程中，利用环状标测导管对肺静脉电位进行实时记录。消融终点为肺静脉完全电隔离。术后进行常规随访。结果在进行了平均（14．0±4．3）次／例消融后，以上70例患者的282支肺静脉中有274支（97．2％）达到了成功电隔离。平均手术时间为（115．2±24．8）min，透视时间（29．6±8．9）min。总计232支（84．3％）肺静脉成功实时记录肺静脉电隔离。其中持续隔离组的电隔离时间（45．61±1．97）s，显著短于传导恢复组（97．30±7．57）s，P〈O．0001。持续隔离组的首次电隔离的球囊最低温度（-46．35±0．55）℃，也显著低于传导恢复组（-40．16±1．26）℃，P〈O．0001，而两组隔离时球囊温度差异无统计学意义[持续隔离组：（-33．95±0．69）℃，传导恢复组：（-36．42±2．0）℃，P=0．1428]。60s的隔离时间为预测术中肺静脉持续隔离的最佳界值（敏感性0．76，特异性0．82）。平均随访5．1个月，空窗期后成功率为76％。多因素分析证实左心房扩大、吸烟和早期复发为房颤复发的独立危险因素。结论冷冻球囊导管操作相对简单，学习曲线较短。在冷冻球囊导管对肺静脉进行消融时，利用环状标测导管可以在大多数肺静脉中记录到肺静脉电位。肺静脉电隔离时间可以有效预测术中肺静脉恢复传导。冷冻球囊导管治疗房颤是安全、有效的。Objective To summarize the application of cryoballoon technique for the treatment of atrial fibrillation （AF） in a Chinese arhythmia center and report the short-term outcomes. Methods Seventy patients with AF underwent cryoballoon ablation were consecutively included. Good occlusion of pulmonary veins （PV） was attempted. During ablation, real-time PV potentials were recorded using an integrated circular map± ping catheter. After successful PV isolation, a waiting period of 30 minutes was applied to access early reconduc- tion. Reconducted PVs were to cryoablation again to achieve full scale PV isolation at the end of the procedure. A blank window of 3 months was applied in follow-up. Results Fifty-seven patients with paroxysmal AF and 13 patients with persistent AF were consecutively included. After an average of （14.0±4. 3 ） cryoablation applications, PV isolation was achieved in 274 of 282 （97. 2% ） PVs. Procedural duration was （ 115.2 ±24. 8） min and fluoroscopy time was （ 29. 6 ± 8.9 ） min. Real-time PVs potential recording during cryoablation was achieved in 232 （84. 3% ） PVs. Regarding time to effect,a cut off value of 60 s was predictive of persistent P± isolation （PVI） with a sensitivity of 0.76 and specificity of 0.82 （ area under curve = 0. 835 ; P〈0. 0001 ）. The overall complication rate was 2. 8% with two cases of transient hemoptysis and persistent phrenic nerve palsy,respectively. During a median follow-up of 5.1 （ range 2. 2 - 14. 3 ） months, early recurrence was observed in 20 （28. 6% ） patients. 76% of patients were free of AF recurrence with a blanking period of 3 months. Multivariate analysis showed that enlarged LA [ hazard ratio（ HR）, 1.41 ;195% confidence interval （ CI）, 1.13-1.75;P = 0.002] ,current smoking（HR 2.44;95% CI, 1.21-5.67;P=0.016） and early recurrence（HR 19.3;95% CI,3.87-96. 58;P〈0. 001 ） were predictors of late recurrence. Conclusion Cryoablation is a feasible, safe and effective technique for the treatment of

关 键 词：心房颤动 冷冻球囊导管 肺静脉电位 球囊温度 随访 

分 类 号：R541.75[医药卫生—心血管疾病]