消融指数指导持续性心房颤动的二尖瓣峡部射频消融  

Ablation index guided mitral isthmus radiofrequency ablation of persistent atrial fibrillation

作　　者：陶海龙[1] 朱揆[1] 赵江涛[1] 陈晓伟[1] 董建增[1] Tao Hailong;Zhu Kui;Zhao Jiangtao;Chen Xiaowei;Dong Jianzeng(Cardiology Department of the First Affiliated Hospital of Zhengzhou University,450052 Zhengzhou,China)

机构地区：[1]郑州大学第一附属医院心内科,450052

出　　处：《中华心律失常学杂志》2020年第3期298-302,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的:采用消融指数(ablation indeax,AI)指导持续性心房颤动(房颤)消融,评价二尖瓣峡部消融的即刻疗效及对远期预后影响。方法:回顾性分析2018年1月至9月郑州大学第一附属医院心内科80例持续性房颤患者(男48例),采用环肺静脉消融及辅助线(二尖瓣峡部、左心房顶部、三尖瓣峡部)消融。简单随机法分为两组:AI指导消融组(A组)与压力指导消融组(B组)。比较两组患者术中各消融参数的差异:复律后肺静脉隔离率、复律后即刻二尖瓣峡部传导阻滞率、最终二尖瓣峡部传导阻滞率、二尖瓣峡部消融时间、手术时间及围术期并发症。评价不同消融方法对术后成功率的影响。结果:患者年龄(60.6±10.3)岁,年龄范围32~75岁,两组患者的基线资料差异无统计学意义。两组患者复律后肺静脉隔离率(92.5%对85.0%, P=0.32)、最终二尖瓣峡部传导阻滞率(87.5%对75.0%, P=0.12),差异无统计学意义。A组患者复律后即刻二尖瓣峡部传导阻滞率(55.0%对17.5%, P<0.01)较B组提高,二尖瓣峡部消融时间[(15.1±3.2)min对(16.7±3.6)min,(P=0.04)]、手术总时间[(127.1±4.7)min对(131.1±9.7)min,(P=0.02)]较B组减少。两组均无严重围术期并发症发生。随访期间,A组患者成功率高于B组(82.5%对62.5%, P=0.045)。 结论:AI指导持续性房颤的二尖瓣峡部消融可提高阻滞效率,缩短手术时间,提高远期成功率。Objective To explore the efficacy of ablation index(AI)for mitral isthmus(MI)radiofrequency ablation of persistent atrial fibrillation.Method From January 2018 to September 2018,eighty patients(including forty-eight in male)with persistent atrial fibrillation were undergone catheter ablation in the cardiology department of the First Affiliated Hospital of Zhengzhou University.They were randomly divided into AI guided group(Group A)and contact force guided group(Group B)for pulmonary vein(PVI)and extra liner ablation,including MI,roof line and cardiac tricuspid isthmus.We sought to compare the difference between two groups in acute PVI after cardioversion,the acute MI conduction block after cardioversion,final MI conduction block,MI ablation time,overall operation time,periprocedure complication and success rate in follow-up.Results There were no significant differences in clinical characteristics,with the average age of(60.4±10.3)years,range 32-75 years.The acute PVI after cardioversion(92.5%vs.85.0%,P=0.32)and final MI conduction block(87.5%vs.75.0%,P=0.12)were compatible in two groups.But in Group A,the acute MI conduction block after cardioversion was higher(55.0%vs.17.5%,P<0.01),the MI ablation time and overall operation time was shorter[(15.1±3.2)min vs.(16.7±3.6)min,P=0.04;(127.1±4.7)min vs.(131.1±9.7)min,P=0.02].No major periprocedure complications were observed.At the end of follow-up,the rate of freedom from atrial fibrillation was higher in group A than in group B(82.5%vs.62.5%,P=0.045).Conclusion AI guided ablation for persistent atrial fibrillation can improve the efficacy of MI block,decrease operation time and increase the future success rate.

关 键 词：心房颤动 消融指数 二尖瓣峡部 射频消融 

分 类 号：R541.75[医药卫生—心血管疾病]