射频消融及冷冻消融在阵发性心房颤动治疗中的曝光量对比  

Comparison of fluoroscopy use between cryoballoon and radiofrequency catheter ablation for paroxysmal atrial fibrillation

作　　者：索妮 牛国栋[1] 褚红涛[2] 林锦璇[1] 邸亚丽[3] 冯天捷[1] 郑黎晖[1] 丁立刚[1] 樊晓寒[1] 刘志敏[1] 陈刚[1] 姚焰[1] 张澍[1] Suo Ni;Niu Guodong;Chu Hongtao;Lin Jinxuan;Di Yali;Feng Tianfie;Zheng Lihui;Ding Ligang;Fan Xiaohan;Liu Zhiming;Chen Gang;Yao Yan;Zhang Shu(Center of Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 10037, China)

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 [2]山东省枣庄市立医院心内科 [3]河北省唐山市唐山工人医院心内科

出　　处：《中华心律失常学杂志》2018年第2期140-145,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 比较射频消融（radiofrequency ablation,RFA）及冷冻球囊消融（cryoballoon ablation, CBA）治疗阵发性心房颤动（paroxysmal atrial fibrillation,PAF）中X线曝光情况.方法 采用单中心前瞻性队列研究设计,连续入组43例PAF患者（RFA 21例,CBA 22例）.所有手术均在同一心血管造影机完成且参数设置相同.对比术中各主要环节的X线曝光时间和X线曝光量情况.同时对手术时间、即时成功率以及安全性也做了相应的对比.结果 两组患者的基线特征差异无统计学意义.与RFA组相比,CBA组总X线曝光时间明显延长[CBA （14.9±3.4） min 对RFA （10.0±4.5） min,P=0.002）],总X线曝光量明显增高[CBA （189.2±85.4） mGy对RFA（59.6±34.9） mGy,P〈0.001],差异均有统计学意义.X线曝光量的差异主要产生于左心房内操作部分[CBA （179.2±23.1） mGy对RFA （41.6±23.1） mGy, P〈 0.001].CBA组肺静脉隔离中4支肺静脉操作的X线曝光量差异无统计学意义[左上肺静脉（LSPV） （39.4±22.4） mGy,左下肺静脉（LIPV）（32.9±24.9） mGy,右下肺静脉（RIPV）（19.8±12.5） mGy,右上肺静脉（RSPV）（29.6±17.0） mGy,P=0.155].两组手术总时间分别为[RFA（96.0±20.8） min对CBA（100.4± 15.7） min,P=0.451];即时肺静脉隔离率均为100%;并发症发生率[RFA 0%（0/21）,CBA 4.5%（1/22）, P=1.000],差异均无统计学意义.结论 在PAF术中,CBA组X线曝光水平高于RFA组,在左心房操作部分体现更为显著,就比较参数而言,X线曝光量较曝光时间能更好地体现手术中实际的X线曝光情况.Objective This study aims to compare the fluoroscopy use between cryoballoon ablation （CBA）and radiofrequency ablation（RFA）for the treatment of paroxysmal atrial fibrillation（PAF）. Method The study was designed as a single-centered prospective cohort protocol. 43 continuous patients （RFA,21,CBA, 22）were alternatively enrolled. The fluoroscopy equipment and parameter setting was same for the two groups. Detailed information about the fluoroscopy use including time and dose usage was recorded for every major step. Procedure time,acute pulmonary vein isolation （PVI）rates and complications were also recorded. Results No significant differences on baseline characteristics were observed between the two groups. The fluoroscopy time for CBA group was longer than RFA group [RFA（10.0±4.5） min vs. CBA（14.9±3.4） min,P〈0.001]. The fluoroscopy dose was substantially higher in CBA group compared with RFA group for total procedure[RFA,（59.6±34.9）mGy vs.CBA,（189.2±85.4）mGy,P〈0.001],and more prominent in left atrial dwell period [CBA,（179.2±23.1）mGy vs. RFA,（41.6±23.1）mGy,P〈0.001]. The differences of fluoroscopy dose among 4 pulmonary veins （PVs）in CBA group did not achieve statistical significance left superior pulmonary vein（LSPV） 39.4±22.4 mGy,left inferior pulmonary vein（LIPV） 32.9±24.9 mGy,right inferior pulmonary vein （RIPV） 19.8±12.5 mGy,right superior pulmonary vein（RSPV） 29.6±17.0 mGy;P=0.155）. The total procedure time [RFA,（96.0±20.8）min,vs. CBA,（100.4±15.7）min,P=0.451],acute PVI successful rate （100% in both groups）and acute phase complication rate （RFA,0%;CBA,4.5%,P=1.000）were similar between RFA and CBA group. Conclusion In this study,both the fluoroscopy time and fluoroscopy dose were higher in CBA group compared with that in RFA group,especially in left atrium dwell period. The fluoroscopy dose might represent the actual fluoroscopy exposure better than fluoroscopy time during procedure.

关 键 词：心房颤动 射频消融 冷冻消融 

分 类 号：R541.75[医药卫生—心血管疾病]