磁导航指导下持续性心房颤动导管消融术后复发因素的分析  

Analysis of recurrence factors in patients with persistent atrial fibrillation after catheter ablation guided by magnetic navigation system

作　　者：赵晓溪 李库林 郑杰 刘晓宇 张常莹 党时鹏 承燕 郁志明 王如兴 Zhao Xiao-xi;Li Ku-lin;Zheng Jie;Liu Xiao-yu;Zhang Chang-ying;Dang Shi-peng;Cheng Yah;Yu Zhi-ming;Wang Ru-xing(Department of Cardiology,Wuxi People＇s Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院心内科,江苏南京214023

出　　处：《实用心电学杂志》2018年第4期245-250,共6页Journal of Practical Electrocardiology

基　　金：国家自然科学基金资助项目(81770331);江苏省自然科学基金资助项目(BK20151110)

摘　　要：目的探讨磁导航指导下持续性心房颤动(房颤)导管消融患者术后复发的危险因素。方法在磁导航指导下,对49例持续性房颤患者行双侧肺静脉前庭电隔离+左心房顶部和二尖瓣峡部线性消融术。术后随访一年,分为房颤复发组(n=21)和房颤未复发组(n=28),比较两组患者手术操作时间、建模时间、肺静脉隔离时间、X线暴露时间、肺静脉前庭隔离急性成功率、手术相关并发症发生率及49例患者术后1个月、3个月、6个月和12个月的房颤复发率。结果 49例患者均成功实施左心房建模、标测和消融;复发组和未复发组手术操作时间、建模时间、肺静脉隔离时间、消融时间、X线暴露时间和肺静脉前庭隔离急性成功率差异均无统计学意义(P>0.05)。两组患者均未发生肺静脉狭窄、心脏穿孔、心包填塞和猝死等严重并发症。随访一年,持续性房颤消融成功率为57.1%;Cox回归分析提示术前房颤发作时间及合并冠心病与术后房颤复发有关。结论磁导航指导下持续性房颤导管消融具有较高的有效性和较好的安全性。术前房颤持续时间及合并冠心病是术后持续性房颤复发的独立危险因素。Objective To investigate the recurrence factors in patients with persistent atrial fibrillation（ PAF）after catheter ablation guided by magnetic navigation system.Methods Bilateral pulmonary vein antrum isolation（ PVAI） plus linear ablation at left atrial（ LA） roof and mitral isthmus were performed in 49 PAF patients using magnetic navigation system.After one-year follow-up,49 patients were divided into AF recurrence group（ 21 cases） and AF non-recurrence group（ 28 cases）.We separately compared the procedure time,duration of LA modelling,duration of PVAI,X-ray exposure time,acute success rate of PVAI,incidences of procedure-related complications,and AF recurrence rates at 1 month,3 months,6 months and 12 months respectively between the two groups.Results LA modelling,mapping and ablation were successfully performed in 49 cases.Between the two groups,the procedure time,modelling time,duration of PVAI,abaltion duration,X-ray exposure time and acute success rate of PVAI did not vary significantly（ P 0.05）.No serious complications such as pulmonary vein steno-sis,cardiac perforation,pericardial tamponade and sudden death occurred in either of the two groups.The success rate of PAF ablation was 57.1% during 1 year of follow-up.Cox regression analysis indicated that the lasting time of preoperative AF and coronary heart disease were associated with postoperative AF recurrence.Conclusion The efficacy and safety of PAF ablation are pretty good using magnetic navigation system.The lasting time of preoperative AF and coronary heart disease are independent risk factors of postoperative AF recurrence.

关 键 词：磁导航系统 持续性心房颤动 导管消融 复发 危险因素 

分 类 号：R541.75[医药卫生—心血管疾病]