高功率短时程射频消融治疗心房颤动安全性和有效性评价  

Safety and effectiveness evaluation of high power short-term radiofrequency ablation for atrial fibrillation

作　　者：蔡衡[1] 郑红梅 李洪仕[1] 薛利[1] 刘梅 张茹霞 杜鑫[1] 程晔[1] 张亮[1] 朱可佳[1] 王蓓[1] 高玉霞[1] 杨清 周金台[1] Cai Heng;Zheng Hongmei;Li Hongshi;Xue Li;Liu Mei;Zhang Ruxia;Du Xin;Cheng Ye;Zhang Liang;Zhu Kejia;Wang Bei;Gao Yuxia;Yang Qing;Zhou Jintai(Department of Cardiology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院心内科,300052

出　　处：《中华心律失常学杂志》2019年第6期485-491,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的观察50~60 W高功率导管射频消融治疗心房颤动(房颤)的即刻疗效、手术效率和围术期安全性。方法回顾性分析天津医科大学总医院2019年4~9月由一名医师完成50~60 W高功率双侧肺静脉隔离(pulmonary venous isolation,PVI)的房颤患者72例,均为首次接受导管消融的阵发性或持续性房颤患者,依照本中心诊疗常规接受围术期管理,并依照房颤类型和术中发作情况选择合理术式进行导管射频消融治疗。高功率消融以消融指数(ablation index,AI)为指导(预设AI参考值:前壁450、后壁350)。分析患者基线资料、手术即刻成功率、PVI单圈隔离率、消融时间和操作时间以及围术期并发症。结果72例患者,平均年龄(66.00±9.98)岁,男39例(39/7254.17%),左心房内径(41.54±5.24)mm,阵发性房颤46例,CHA2DS2-VASc评分2.81±1.62。其中55例接受60 W消融(60 W组),17例接受50 W消融(50 W组),均在手术结束时恢复窦性心律。全部患者双侧PVI单圈隔离率为87.5%(阵发性房颤为93.48%),消融时间为(924.90±316.24)s,双环操作时间为(28.89±10.16)min;60 W组双侧PVI单圈隔离率为89.09%(阵发性房颤为94.59%),消融时间为(855.93±306.78)s,双环操作时间为(26.62±9.79)min;50 W组双侧PVI单圈隔离率为82.35%,消融时间为(1148.06±238.49)s,双环操作时间为(36.24±7.75)min。3例(3/72,4.17%)患者术中出现了气体爆裂,但未发生心脏压塞事件。1例患者术后出现阴道出血,1例患者出现股动静脉瘘并接受外科治疗,非消融相关并发症发生率为2.78%(2/72)。结论基于AI预设AI的50~60 W高功率短时程射频消融是一种安全高效的房颤消融策略,但其长期有效性和安全性有待进一步评估。Objective To observe the immediate efficacy,operational efficiency and perioperative safety of high power(50-60 W)radiofrequency ablation for atrial fibrillation(AF).Methods A total of 72 patients with AF were analyzed retrospectively,who were admitted to Tianjin Medical University General Hospital from April to September 2019,and received 50-60 W high-power bilateral pulmonary venous isolation(PVI)by the same practitioner.All patients with paroxysmal or persistent AF underwent catheter ablation for the first time.Perioperative management was performed according to the routine of our center.And catheter ablation was performed according to the type of AF and the intraoperative seizure.High power ablation was guided by ablation index(AI)or predicted AI(reference values:450 for anterior wall,and 350 for posterior wall).The patients’baseline data,immediate success rate,single-turn isolation rate of PVI,ablation time,and operating time,as well as perioperative complications were analyzed.Results A total of 72 patients were analyzed,with average age of(66.00±9.98)years,males accounted for 54.17%,left atrial anteroposterior diameter of(41.54±5.24)mm,paroxysmal AF accounted for 63.99%,CHA2DS2-VASc scores of(2.81±1.62).Fifty-five patients received ablation using 60 W,while 17 patients were ablated using 50 W,and all patients were recovered to sinus rhythm at the end of operation.For all patients,the single-turn isolation rate of bilateral PVI was 87.5%(93.48%for paroxysmal AF),while the ablation time was(924.90±316.24)s,and the double-loop operation time was(28.89±10.16)minutes.In 60 W group,the single-turn isolation rate of bilateral PVI was 89.09%(94.59%for paroxysmal AF),while the ablation time was(855.93±306.78)s,and the double-loop operation time was(26.62±9.79)minutes.In 50 W group,the single-turn isolation rate of bilateral PVI was 82.35%,while the ablation time was(1148.06±238.49)s,and the double-loop operation time was(36.24±7.75)minutes.Three patient(3/72)developed steam pop during operation without c

关 键 词：阵发性房颤 窦性心律 诊疗常规 持续性房颤 心脏压塞 导管消融 基线资料 心房颤动 

分 类 号：R54[医药卫生—心血管疾病]