压力感知导管在心房颤动导管消融中的价值  

The value of contact force sensing catheter in catheter ablation of atrial fibrillation

作　　者：乔宇[1] 姚焰[1] 吴灵敏[1] 侯炳波[1] 陈刚[1] 丁立刚[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4期284-288,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的非透壁性损伤是心房颤动（房颤）导管消融术后复发的重要原因,本研究旨在应用压力感知导管观察左心房不同部位的导管贴靠情况并了解其对消融效果的潜在影响.方法共纳入2014年3月至5月在阜外医院心律失常中心首次接受射频消融治疗的房颤患者23例,男21例,平均年龄（53.6±10.6）岁,其中15例阵发性房颤,采用压力感知导管,在关闭压力显示窗口下由同一名熟练消融术者在左心房15个部位（左心耳-左肺静脉嵴部上、中、下段;顶部-左上肺静脉口、正中、顶部-右上肺静脉口;左上-下肺静脉间后壁、右上-下肺静脉间前、后壁;二尖瓣峡部游离壁上、中、下段、间隔峡部上、中、下段）进行贴靠,操作者采用传统方法根据局部电位大小、阻抗、透视及三维导航判断贴靠满意时记录导管-心房接触力（contactforce,CF）.CF＜10g为贴靠不佳,10g～＜40g为贴靠良好,≥40g为过度贴靠.结果在23例房颤患者中共记录345个点,CF中位数为25g（Q3：10～23g）,其中,贴靠不佳、贴靠良好、过度贴靠的点分别为85个（24.6％）、241个（69.9％）、19个（5.5％）.贴靠不佳的位置最常见于嵴部上、中、下段,其CF分别为7g（Q1-Q3：3～12g）、8g（Q1-Q3：4～12g）及10g（Q1-Q3：4～22g）,贴靠不佳的点分别占56.5％（13/23）、52.2％（12/23）及47.8％（11/23）.过度贴靠的位置最常见于顶部-右上肺静脉口、间隔峡部上、中段,其CF分别为27g（Q1-Q3：17～32g）、26g（Q1-Q3：13～37g）及23g（Q1-Q3：20～30g）,过度贴靠的点分别占17.4％（4/23）、21.7％（5/23）及17.4％（4/23）.结论在传统消融方法下,左心耳-左肺静脉嵴部是导管贴靠最困难的位点,可能为房颤复发的重要原因,而右侧肺静脉口周围则易压力过高,导致心脏压塞的风险相对较高.Objective The inability to create transmural lesions may cause atrial fibrillation recurrence after catheter ablation.The aim of the present study was to evaluate the catheter-tissue contact at different sites in left atrium with the contact force（CF） sensing catheter and the potential impact on ablation outcome.Methods Twenty-three patients with atrial fibrillation referred to Fuwai Hospital for the first-time catheter ablation from March to May,2014 were enrolled [21 males,（53.6± 10.6） years old,15 cases of paroxysmal atrial fibrillation].Without the contact indicating window,a single experienced operator attempted to achieve qualified contact in 15 left atrium sites （superior,middle and inferior part of the ridge between left pulmonary vein and left atrial appendage;left,middle and right part of the roof;posterior conjunction of left superior pulmonary vein and left inferior pulmonary vein;anterior,posterior conjunction of right superior pulmonary vein and right inferior pulmonary vein;superior,middle and inferior part of mitral isthmus;superior,middle and inferior part of septal isthmus） using the CF sensing catheter.The CF was recorded when qualified contact was considered according to the conventional criteria including electrogram amplitude,impedance,fluoroscopy and 3D navigation.Inadequate contact,qualified contact and excessive contact were defined when CF〈 10 g,10-〈40 g and ≥40 g,respectively.Results In total,345 points were recorded in 23 patients,with the median of the CF 25 g （Q l-Q3：10-23 g）.Among them,points with inadequate,qualified and excessive contact were 85 （24.6%）,241 （69.9%） and 19（5.5%）,respectively.Superior,middle and inferior ridge were the most common sites with inadequate contact,with median CF 7 g （Q1-Q3：3-12 g）、8 g （Q1-Q3：4-12 g） and 10 g （Q1-Q3：4-22 g）.Points with inadequate contact accounted for 56.5% （13/23）,52.2% （12/23） and 47.8% （11/23）,respectively.In contrast,right roof,superior and middle of septal isthmus

关 键 词：心房颤动 导管消融 接触力 嵴部 

分 类 号：R541.75[医药卫生—心血管疾病]