消融指数指导心房颤动导管消融的短期疗效及安全性  

Short-term efficacy and safety of catheter ablation guided by ablation index in patients with atrial fibrillation

作　　者：王温立 邹操[1] 李勋[1] 林佳[1] 杜小娇 孙世坤[1] 宣勤考 孟晶 蒋廷波[1] WANG Wen-li;ZOU Cao;LI Xun;LIN Jia;DU Xiao-jiao;SUN Shi-kun;XUAN Qin-kao;MENG Jing;JIANG Ting-bo(Cardiology Department,the First Hospital Affiliated of Soochow,University,Suzhou 215000,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院心血管内科,江苏苏州215000

出　　处：《中国心脏起搏与心电生理杂志》2020年第4期337-341,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：2018年苏州市卫生青年骨干全国导师制培训项目;苏州大学横向课题(编号:H190426)。

摘　　要：目的探讨消融指数(AI)指导心房颤动(简称房颤)导管消融的短期疗效及安全性。方法选择2018年6月至2019年5月在苏州大学附属第一医院拟行射频消融术的房颤患者116例为研究对象,其中阵发性房颤患者75例、持续性房颤患者41例。所有患者均在Carto3三维标测系统AI指导下应用压力监测导管行环肺静脉隔离及心房线性消融,相邻消融点间距离<6 mm,肺静脉前壁和嵴部AI≥400以及后壁、顶部和下壁AI≥300为消融目标。术后每3个月随访1次,若患者出现症状及时行心电图和24 h动态心电图检查。消融成功标准:3个月空白期后无抗心律失常药物的情况下未发生持续时间>30 s的房性心律失常。结果①AI指导下房颤消融时间为(60.8±10.6) min,每消融点阻抗下降为(11.5±6.3)Ω,肺静脉单圈隔离成功率为91%;②随访时间为(9.1±3.2)个月,失访3例,阵发性和持续性房颤患者消融成功率分别为90.4%及87.5%;③在围手术期及随访过程中,仅术中发生1例一过性脑缺血发作,术后心脏超声发现少量心包积液2例,无心包压塞、脑栓塞、肺静脉狭窄和心房食管瘘等严重并发症。结论 AI指导下行房颤导管消融术是安全可行的,可提高房颤消融效率、肺静脉单圈隔离率及短期疗效。Objective To investigate on the short-term efficacy and safety of catheter ablation guided by the ablation index(AI) in patients with atrial fibrillation(AF). Methods One hundred sixteen consecutive patients including paroxysmal(ParAF,n=75) or persistent(PerAF,n=41) AF underwent antral pulmonary vein(PV) isolation or atrial linear ablation using a CF-sensing catheter guided by AI in the first hospital affiliated of Soochow university from June 2018 to May 2019. Radiofrequency was delivered at PV antrum with targeting inter-lesion distance <6 mm and AI value of more than 300 was set at PV posterior,roof and inferior wall and more than 400 at PV anterior and ridge wall. Patients were followed up per 3-month after ablation. An electrocardiogram and Holter were performed timely in symptomatic patients. Ablation success criterion was that no AF, atrial tachycardia(AT) or atrial flutter(AFL) occurred lasting more than 30 s without anti-arrhythmic drugs after 3-month blank period. Results Ablation guided by AI presented that mean ablation time was(60.8±10.6) min, mean dropped impedance was(11.5±6.3)Ω and incidence of first-pass isolation of PV was 91%. During a mean follow-up of(9.1±3.2) months, single-procedure freedom from AF/AT/AFL were 90.4% and 87.5% in ParAF and PerAF patients respectively. During ablation, one case with transient ischemic attack was observed,and two cases with small amount of pericardial effusion were detected after ablation. There were no serious complications such as pericardial tamponade, cerebral embolism, PV stenosis and atrial esophageal fistula during perioperative and follow-up period. Conclusion Catheter ablation guided by AI was feasible and safe with shorter procedure time, resulting in higher rate of PV isolation and shot-term success.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(4):337-341]

关 键 词：心血管病学 心房颤动 消融指数 导管消融 疗效 安全性 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]