心房颤动患者行节段性射频消融隔离上腔静脉的有效性和安全性评价研究  

Efficacy and safety of segmental radiofrequency ablation for isolation of the superior vena cava in patients with atrial fibrillation

作　　者：陈英伟[1] 王喆 孙莉萍 陈晓杰[1] 王徐乐[1] 李然[1] 董建增[1] Chen Yingwei;Wang Zhe;Sun Liping;Chen Xiaojie;Wang Xule;Li Ran;Dong Jianzeng(Department of Cardiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,450052

出　　处：《中华心血管病杂志》2021年第3期229-235,共7页Chinese Journal of Cardiology

基　　金：北京心联智成心电生理培训基金 (2019-Z-06-2001);河南省医学科技攻关计划联合共建项目 (LHGJ20190094)。

摘　　要：目的分析心房颤动(房颤)患者导管三维电生理方法确定功能性窦房结、右侧膈神经及上腔静脉-右心房肌束的分布,探讨房颤节段性射频消融隔离上腔静脉的有效性和安全性。方法本研究为回顾性研究,选取2018年7月至2019年6月于郑州大学第一附属医院首次行导管射频消融术并且接受上腔静脉隔离术的房颤患者为研究对象,收集患者的基线临床资料。所有患者均在窦性心律下行上腔静脉隔离,激动标测定位功能性窦房结,三维标测(Carto)系统指导下起搏、标测并定位右侧膈神经,根据上腔静脉隔离术中电位的变化确定上腔静脉-右心房肌束,节段性消融上腔静脉完成隔离,分析功能性窦房结、右侧膈神经及上腔静脉-右心房肌束的三维分布情况。术后即刻评估患者是否存在并发症(窦房结功能障碍、膈神经麻痹或上腔静脉狭窄),并在术后3、6、9、12个月进行门诊或电话随访,每3个月行动态心电图检查,每6个月行胸部透视和上腔静脉彩色多普勒超声检查,评估并发症发生情况。结果136例房颤患者年龄(51.6±14.2)岁,男性86例(63.2%),阵发性房颤98例(72.1%),持续性房颤患者38例(27.9%)。17例(12.5%)患者功能性窦房结位于上腔静脉内,78例(57.4%)位于上腔静脉-右心房连接处,41例(30.1%)位于连接处以下水平;水平切面从头向足观,83例(61.0%)患者的功能性窦房结位于上腔静脉-右心房三维重建模型的前侧壁,34例(25.0%)位于后侧壁,15例(11.0%)位于前壁,其余4例(2.9%)位于后壁或前间隔;136例患者上腔静脉-右心房肌束总共为294条,其中94条(32.0%)位于上腔静脉-右心房三维重建模型的前间隔,76条(25.9%)位于后间隔,21条(7.1%)位于后游离壁,11条(3.7%)位于后侧壁,27条(9.2%)位于前侧壁,65条(22.1%)位于前壁;右侧膈神经位置比较固定,133例(97.8%)患者的膈神经位于上腔静脉-右心房三维重建模型的外侧壁,3例(2.2%)位于前Objective To analyze the three-dimensional distribution of functional sinus node,right phrenic nerve and superior vena cava(SVC)-right atrial muscle sleeves by three-dimensional electrophysiological technique in patients with atrial fibrillation(AF),and to investigate the efficacy and safety of segmental radiofrequency catheter ablation(RFCA)for isolation of superior vena cava in these patients.Methods In this retrospective study,we enrolled 136 AF patients who underwent first RFCA in the First Affiliated Hospital of Zhengzhou University from July 2018 to June 2019 and all patients underwent SVC isolation under sinus rhythm.Baseline clinical data of patients were collected.The functional sinus node was defined by activation mapping,pacing was guided by three-dimensional mapping(Carto)system,localization of the right phrenic nerve was defined by pacing map,the superior vena cava-right atrial muscle sleeves was determined according to the change of potential during SVC isolation,segmental RFCA was performed for SVC isolation,the three-dimensional distribution of functional sinus node,right phrenic nerve and superior vena cava(SVC)-right atrial muscle sleeves was determined by three-dimensional electrophysiological technique.Immediate SVC isolation was achieved in all patients.Patients were evaluated immediately after RFCA and patients were followed at 3,6,9,and 12 months after RFCA.Holter monitoring was performed every 3 months,the chest radiograph and the SVC ultrasonic examination were performed every 6 months after RFCA.Postoperative complications were assessed.Results The mean age of the 136 patients with AF was(51.6±14.2)years,86(63.2%)were male,98 cases(72.1%)were paroxysmal AF and 38 cases(27.9%)were persistent AF.Right atrium activation mapping revealed that 17(12.5%)functional sinus node were located in the SVC,78(57.4%)were located at the SVC-right atrium junctions,41(30.1%)were located below the junction level.From the head to foot view,83(61.0%)functional sinus node were located at the anterior lateral

关 键 词：心房颤动 射频消融 上腔静脉隔离 

分 类 号：R541.75[医药卫生—心血管疾病]