磁导航系统指导下心房颤动导管消融学习曲线期间有效性和安全性分析  

Effectiveness and safety of atrial fibrillation catheter ablation guided by magnetic navigation system during learning curve

作　　者：郑杰[1] 李库林[1] 刘晓宇[1] 张常莹[1] 李晓燕[1] 李嘉萍[1] 郁志明[1] 王如兴[1] 

机构地区：[1]南京医科大学附属无锡市人民医院心内科,江苏无锡214023

出　　处：《实用心电学杂志》2016年第2期96-100,共5页Journal of Practical Electrocardiology

基　　金：江苏省自然科学基金资助项目(BK20151110);江苏省医学重点人才资助项目(RC201134)

摘　　要：目的探讨磁导航系统(magnetic navigation system,MNS)指导下心房颤动(房颤)导管消融学习曲线期间的有效性及安全性。方法按手术时间顺序,将90例房颤患者分为A、B、C三组,每组30例。穿刺房间隔后采用盐水灌注MNS消融导管行左心房建模和左右肺静脉前庭电隔离,隔离后采用"牛眼图"软件确认。记录并分析三组的手术操作时间、X线暴露时间及暴露量、肺静脉隔离即时成功率和手术相关并发症。术后3至6个月内每月随访一次动态心电图。结果 90例房颤患者均成功实施了MNS指导下的房颤导管消融治疗。三组的手术操作时间相比,差异无统计学意义[(158.4±23.5)min、(150.4±22.5)min和(151.3±23.6)min,P>0.05]。B、C组的X线暴露时间及暴露量较A组显著减少,而B、C组相比,差异无统计学意义[(16.8±7.2)min、(8.2±2.6)min和(7.9±3.4)min,A、B组相比P<0.05;(583.7±460.3)m Gy、(267.3±191.8)m Gy和(225.0±121.0)m Gy,A、B组相比P<0.05]。A组肺静脉隔离即时成功率96.2%,而B、C组皆达到100%;三组比较,差异无统计学意义(P>0.05)。围手术期A组发生2例血胸、1例腹股沟血肿,B组1例新发腔隙性脑梗死,C组未发生并发症;三组之间比较,差异无统计学意义(P>0.05)。随访3至6个月,三组手术成功率比较,差异无统计学意义(P>0.05)。结论 MNS指导下的房颤导管消融治疗具有较好的安全性和有效性,且学习曲线较短。Objective To investigate the effectiveness and safety of atrial fibrillation（ AF） catheter ablation guided by magnetic navigation system（ MNS） during learning curve.Methods In the sequence of operation time,90 AF patients were divided into three groups： group A,B and C,each with 30 cases.After transseptal puncture,left atrial modeling as well as left and right pulmonary vein antrum isolation were performed with irrigated MNS catheter,and confirmed by＂bull-eye＂software after isolation.The procedure time,X-ray exposure time and dose,instant success rate of pulmonary vein isolation and procedure-related complications were recorded and analyzed.Holter recordings for once a month were done during 3 to 6 months＇ follow-up postoperatively.Results Ablation procedures were all performed successfully in 90 AF cases.The differences of procedure durations among the three groups were not statistically significant [（ 158.4 ± 23.5） min,（ 150.4 ±22.5） min and（ 151.3 ± 23.6） min,P〉0.05].The X-ray exposure time and dose were significantly higher in group A than those in group B and C,but similar between the last two groups[（ 16.8 ± 7.2） min,（ 8.2 ± 2.6） min and（ 7.9 ± 3.4） min,P〈0.05 between group A and B;（ 583.7 ± 460.3） m Gy,（ 267.3 ± 191.8） m Gy and（ 225.0 ± 121.0） m Gy,P〈0.05 between group A and B].The instant success rate of pulmonary vein isolation was 96.2% in group A and100% in group B and C.There was no statistically significant difference among the three groups（ P〉0.05）.In perioperative period,2 patients in group A experienced hemothorax,and 1 patient experienced groin hematoma.Meanwhile,1 patient in group B developed lacunar cerebral infarct.No complication happened in group C.There was no statistically significant difference among the three groups（ P〉0.05）.The success rates of operation were almost similar in the three groups during 3 to 6 months＇ follow-up postoperatively.Conclusion MNS-guided AF catheter ablation proves to be safe and ef

关 键 词：磁导航系统 心房颤动 导管消融 学习曲线 有效性 安全性 

分 类 号：R541.75[医药卫生—心血管疾病] R540.4[医药卫生—内科学]