射频消融与冷冻球囊消融治疗阵发性心房颤动的疗效观察  

Efficacy of radiofrequency ablation and cryoballoon ablation for paroxysmal atrial fibrillation

作　　者：白剑[1] 王绍娴 郑甲 李晓宏[1] 陈诤 沈文志 刘宇 顾蓉[1] 马冬辉[1] 徐伟[1] Bai Jian;Wang Shaoxian;Zheng Jia;Li Xiaohong;Chen Zheng;Sheng Wenzhi;Liu Yu;Gu Rong;Ma Donghui;Xu Wei(Department of Cardiology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心内科,210008

出　　处：《中华心律失常学杂志》2020年第3期303-307,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81870291)。

摘　　要：目的:本研究旨在探讨射频消融与冷冻球囊消融治疗阵发性心房颤动(房颤)的安全性和有效性。方法:本研究为回顾性研究,连续入选2014年9月至2018年10月在南京大学医学院附属鼓楼医院首次行射频消融或冷冻球囊消融的阵发性房颤患者。根据手术方式和手术器械分为普通导管组(A组)、压力感知导管组(B组)、一代冷冻球囊组(C组)和二代冷冻球囊组(D组)。观察各组患者手术操作时间、X线曝光时间、手术相关并发症及术后1年房颤复发情况。结果:共有582例患者完成术后1年随访。4组患者基线资料相关指标差异无统计学意义( P>0.05)。A、B、C、D组患者的手术操作时间分别为(163.6±49.3)?min、(142.4±40.5)?min、(136.6±30.4)?min和(114.6±24.2)?min,差异有统计学意义( P<0.01);A、B、C、D组患者的术中X线曝光时间分别为(22.2±8.4)?min、(13.6±8.7)?min、(31.5±7.3)?min和(26.5±8.5)?min,差异有统计学意义( P<0.01);手术并发症方面,行冷冻球囊消融的C组和D组的膈神经麻痹发生率明显高于行射频消融的A组和B组( P<0.05),其他手术并发症发生率的差异无统计学意义( P>0.05)。A、B、C和D组患者术后1年房颤复发率分别为23.8%、15.4%、15.1%、11.6%,其中B组和D组的房颤复发率明显低于A组,差异有统计学意义( P<0.05)。 结论:对于阵发性房颤患者,使用二代冷冻球囊及压力导管射频消融的疗效均优于普通导管射频消融。无论是射频消融还是冷冻球囊消融,手术均是安全的。膈神经麻痹是冷冻球囊消融需要特殊注意的一个并发症。Objective The aim of this study was to investigate the safety and effectiveness of radiofrequency ablation and cryoballoon ablation for paroxysmal atrial fibrillation(AF).Methods This study was a retrospective study.Patients with paroxysmal(AF)who underwent radiofrequency ablation or cryoballoon ablation for the first time in Nanjing Drum Tower Hospital from September 2014 to October 2018 were consecutively enrolled.According to the different procedure methods and instruments,the enrolled patients were divided into four groups:normal saline irrigation catheter group(group A),contact force-sensing catheter group(group B),first-generation cryoballoon group(group C),and second-generation cryoballoon group(group D).The procedure time,X-ray exposure time,procedural complications,and 1-year recurrence rate were observed.Results A total of 582 patients completed 1-year follow-up.There were no significant differences in baseline patient characteristics among the four groups.The procedure times of patients in groups A,B,C,and D were(163.6±49.3)min,(142.4±40.5)min,(136.6±30.4)min,and(114.6±24.2)min,respectively,and the differences were statistically significant(P<0.01).The X-ray exposure times of patients in groups A,B,C,and D were(22.2±8.4)min,(13.6±8.7)min,(31.5±7.3)min,and(26.5±8.5)min,respectively,and the differences were statistically significant(P<0.01).In terms of procedural complications,the incidence of phrenic nerve palsy in groups C and D underwent cryoballoon ablation was significantly higher than those in groups A and B under radiofrequency ablation(P<0.05),and there were no significant differences in the incidence of other procedural complications.The 1-year recurrence rates of atrial fibrillation in groups A,B,C,and D were 23.8%,15.4%,15.1%,and 11.6%,respectively.Among them,the recurrence rates in groups B and D were significantly lower than that in group A(P<0.05).Conclusion Our preliminary findings suggest that the efficacy of using contact force-sensing catheter or second-generation cryoballoon fo

关 键 词：心房颤动 射频消融 冷冻球囊消融 

分 类 号：R541.75[医药卫生—心血管疾病]