左心房大小对磁导航指导下心房颤动射频消融的影响  

Impact of left atrial size on the ablation of atrial fibrillation using remote magnetic navigation

作　　者：刘晓宇[1] 郑杰[1] 李库林[1] 钱玲玲[1] 郁志明[1] 王如兴[1] Liu Xiaoyu;Zheng Jie;Li Kulin;Qian Lingling;Yu Zhiming;Wang Ruxing(Department of Cardiology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡市人民医院心内科,214023

出　　处：《中华心律失常学杂志》2019年第1期57-62,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金青年项目(81500249);无锡市卫生和计划生育委员会科研青年项目(Q201652).

摘　　要：目的探讨左心房大小对磁导航(RMN)指导下心房颤动(房颤)消融的影响。方法2016年8月至2017年8月43例在南京医科大学附属无锡市人民医院接受RMN指导下的房颤射频消融治疗的患者。按照左心房内径大小分为A组(<40mm,16例)和B组(≥40mm,27例)。对比两组手术时间、术中射线应用、手术成功与术后复发等情况。结果与B组相比,A组患者阵发性房颤比例高(15/16对13/27,P=0.002)、左心室射血分数高[63.9%±4.2%对61.1%±3.6%,P=0.026)],Carto3系统建立的左心房模型容积小[(91.8±15.7)ml对(119.6±31.8)ml,P=0.002];A组消融治疗过程中,从建模至消融结束X线曝光时间[(77.3±115.9)s对(9.6±16.5)s,P<0.001]和剂量[(2.6±3.6)gycm^2对(1.0±2.5)gycm^2,P=0.0038]明显增加,且需要多次调整鞘管位置才能完成消融,但手术过程总时间两组差异无统计学意义,两组均无严重并发症发生。两组术中肺静脉隔离成功率差异无统计学意义,但随访发现,与B组相比,A组复发率低,维持窦性心律患者比例高(93.8%对66.7%,P=0.04)。结论RMN指导下的房颤消融手术安全、有效,但对左心房内径较小患者会增加手术操作难度,从而使X线曝光时间和剂量增加。Objective The aim of this study was to investigate the impact of left atrial size on the ablation of atrial fibrillation(AF)using remote magnetic navigation(RMN).Methods From August 2016 to August 2017,a total of 43 patients with AF who underwent catheter ablation using RMN in Wuxi People’s Hospital AF filiated to Nanjing Medical University were included.The patients were divided into two groups based on diameter of the left atrium.Sixteen patients had smaller left atrial size(left atrial diameter<40 mm,group A),and the other 27 patients with left atrial diameter≥40 mm(group B).The parameters,just like procedure duration,X-ray time and dose during ablation,success rate and recurrence rate were compared between the two groups.Results Compared with group B,there were more patients with paroxysmal AF(15/16 vs.13/27,P=0.002)in group A.Left ventricular ejection fraction of group A was higher than that in Group B[63.9%±4.2%vs.61.1%±3.6%,P=0.026)].The volume of the left atrial model built by Carto 3 in group A was smaller[(91.8±15.7)ml vs.(119.6±31.8)ml,P=0.002].During the ablation process,X-ray exposure time[(77.3±115.9)s vs.(9.6±16.5)s,P<0.001]and X-ray dose[(2.6±3.6)gycm^2 vs.(1.0±2.5)gycm^2,P=0.003 8)were significantly increased in group A.No serious complications occurred in all patients.There was no statistical difference in the acute success rate of pulmonary vein isolation between the two groups.However,compared with group B,the recurrence rate of group A was lower and the rate of maintain sinus rhythm was higher(93.8%vs.66.7%,P=0.04)during the follow-up.Conclusions Atrial fibrillation ablation using RMN is safe and effective.However,Patients with smaller left atrial size may increase the difficulty of operation resulting in increased the exposure time and dose of X-rays.

关 键 词：心房颤动 导管消融术 心房功能 左 

分 类 号：R541.75[医药卫生—心血管疾病]