心房颤动冷冻球囊消融术后肺静脉电位恢复的术中因素分析  

Analysis of the factors of pulmonary vein potential recovery after cryoballoon-based ablation for patients with atrial fibrillation

作　　者：吴梅琼[1] 陈林[1] 林亚洲 张建成[1] 杨志平 陈建泉[1] 连亮华[1] Wu Meiqiong;Chen Lin;Lin Yazhou;Zhang Jiancheng;Yang Zhiping;Chen Jianquan;Lian Lianghua(Department of Cardiolody,Fujian Medical University Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院心内科,福州350001

出　　处：《中华心律失常学杂志》2020年第5期450-454,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：福建省科技厅引导性项目(2018Y0014)。

摘　　要：目的探讨心房颤动(房颤)患者冷冻球囊(CB)消融术后复发的好发部位与术中因素。方法入选2017年2月至2019年11月在福建省立医院心内科接受房颤再次手术的房颤患者39例(阵发房颤21例,持续房颤18例)。术中左心房行基质电压标测,记录肺静脉电位恢复部位(GAP)。回顾性分析患者首次手术肺静脉电位记录,肺静脉电位隔离时间(TTI),冷冻30 s时的温度(T30 s)与术后复发的关系。结果①肺静脉电位恢复好发于右前三叉处,左上肺静脉顶部,左下、右下肺静脉的底部;②有记录到肺静脉电位,术后无GAP的敏感性为78%,阳性预测值为80%;③T30 s<-25℃,TTI<60 s的敏感性为84%,阳性预测值为87%;④T30 s<-25℃,术后无GAP的敏感性为87%,阳性预测值为80%。结论右前三叉、左上肺静脉顶部,左下、右下肺静脉的底部是肺静脉电位恢复的好发部位,可记录肺静脉电位、T30 s<-25℃可以预测房颤冷冻消融术效果。Objective To analysis of the factors of pulmonary vein(PV)potential recovery after cryoballoon-based ablation(CBA)for patients with atrial fibrillation(AF).Methods A total of 39 consecutive patients were enrolled in the study from February 2017 to November 2019 in Fujian Provincial Hospital.All patients underwent a repeat procedure after index ablation using the 28 mm second-generation cryoballoon.All repeat ablation were performed by using 3-dimensional electroanatomical mapping system.PV reconnection gap,PV potential,time to isolation(TTI),temperature in 30 s were recorded(T30 s).Results Among all 156 PV,it showed that the potential recovery of PV potential was mainly at the right anterior trigeminal,the top of left upper PV,the bottom of left lower pulmonary vein and right lower pulmonary vein.Among patients with PV potential,the sensitivity without PV potential recovery site was 78%and the positive predictive value was 80%.Success to achieve-25℃in 30 s(T30 s<-25℃)independently predicted time to isolation(TTI<60 s)(sensitivity,84%;positive predictive value,87%).T30 s<-25℃identified the absence of PV recondition(sensitivity,87%;positive predictive value,80%).Conclusion PV reconnections was mainly at the right anterior trigeminal,the top of left upper PV,the bottom of left lower pulmonary vein and right lower PV.PV potential,T30 s<-25℃were predictors of the PV reconnection after cryoablation in patients with AF.

关 键 词：心房颤动 冷冻球囊消融 肺静脉电位恢复 消融温度 

分 类 号：R541.75[医药卫生—心血管疾病]