心腔内超声辅助房间隔穿刺术应用于心房颤动患者射频消融治疗的可行性及安全性探讨  

Feasibility and safety of intracardiac ultrasound-assisted atrial septal puncture during radiofrequency ablation for atrial fibrillation

作　　者：左嵩[1] 桑才华[1] 龙德勇[1] 薄小雯 赖一炜 李梦梦[1] 何柳 赵欣[1] 李松南[1] 蒋晨曦[1] 汤日波[1] 杜昕[1] 董建增[1] 马长生[1] Zuo Song;Sang Caihua;Long Deyong;Bo Xiaowen;Lai Yiwei;Li Mengmeng;He Liu;Zhao Xin;Li Songnan;Jiang Chenxi;Tang Ribo;Du Xin;Dong Jianzeng;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing 100029,China)

机构地区：[1]国家心血管病临床医学研究中心首都医科大学附属北京安贞医院心血管内科,100029

出　　处：《中华心血管病杂志》2021年第5期474-478,共5页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2016YFC1301002,2016YFC0900901,2020YFC2004803);国家自然科学基金(82000322)。

摘　　要：目的:探讨心腔内超声辅助房间隔穿刺术应用于心房颤动(房颤)患者射频消融治疗的可行性及安全性。方法:该研究为观察性研究。连续入选2020年7至9月于北京安贞医院接受射频消融治疗的房颤患者,入选患者年龄均≥18岁且心电图明确记录存在房颤。根据是否采用了心腔内超声辅助穿刺将患者分为两组,即心腔内超声辅助X线行房间隔穿刺组(超声组)和X线辅助下行房间隔穿刺组(X线组)。记录入选患者的基线资料,包括年龄、性别、阵发房颤比例、再次消融比例、CHA 2DS 2-VASc评分、既往史[包括高血压、糖尿病、冠心病、卒中/一过性脑缺血发作(TIA)、心脏瓣膜病、扩张型心肌病、肥厚型心肌病]、超声心动图参数(包括左心房前后径、左心室射血分数、左心室舒末期内径)。记录两组患者首次出针的情况并计算成功率以及房间隔穿刺时间、放射暴露时间及房间隔穿刺并发症等指标。结果:研究共纳入患者241例,其中超声组123例、X线组118例。入选患者的年龄为(62.5±8.0)岁,男性138例(57.0%),其中阵发性房颤患者135例(56.0%),再次消融的患者43例(17.8%)。两组患者的年龄、性别、阵发性房颤患者的比例以及有高血压、糖尿病病史患者的比例等差异均无统计学意义(P均>0.05)。与X线组比较,超声组患者左心室射血分数较低[(61.7±4.9)%比(63.0±4.4)%,P=0.022],左心室舒张末期内径较大[(48.0±2.9)mm比(47.0±3.4)mm,P=0.011]。超声组患者房间隔首次出针成功率高于X线组[94.3%(116/123)比79.7%(94/118),P=0.001],射线暴露时间短于X线组[(31.3±7.9)s比(124.8±35.7)s,P<0.001)],而房间隔穿刺时间较X线组长[(10.1±1.8)min比(8.2±1.3)min,P<0.001]。并发症方面,与X线组比较,超声组误穿心包的发生率较低[0比3.4%(4/118),P=0.039],穿间隔后一过性ST段抬高发生率略高,但差异无统计学意义[2.4%(3/123)比1.7%(2/118),P=0.999]。结论:心腔内超�Objective To explore the feasibility and safety of intracardiac ultrasound-assisted atrial septal puncture(ASP)during radiofrequency ablation for atrial fibrillation.Methods We enrolled 241 consecutive patients scheduled to radiofrequency ablation for atrial fibrillation in Beijing Anzhen Hospital from July to September 2020.Inclusion criteria:patients aged over 18 years with a clear electrocardiogram record of atrial fibrillation.Patients were divided into 2 groups:ASP with ultrasound-assisted X-ray(ultrasound group,n=123),ASP under X-ray alone(X-ray group,n=118).Clinical features of patients including age,sex,percent of paroxysmal atrial fibrillation,and repeat ablation,CHA2DS2-VASc score and past history(hypertension,diabetes mellitus,coronary artery disease,stroke/transient ischemic attack(TIA),valve diseases)and echocardiographic parameters(left atrial dimension,left ventricular ejection fraction,left ventricular end-diastolic dimension)were obtained and compared.The first-pass rate,radiation exposure time,duration of ASP,and complications of ASP were also compared between the two groups.Results The age of patients in this cohort was(62.5±8.0)years,and the proportion of males was 57.0%(n=138).Among them,the proportion of paroxysmal atrial fibrillation was 56.0%(n=135),and the ratio of repeat ablation was 17.8%(n=43).Age,sex,percent of paroxysmal atrial fibrillation,history of hypertension,diabetes mellitus were similar between the two groups.The first-pass rate was significantly higher in the ultrasound group than in the X-ray group(94.3%(116/123)vs.79.7%(94/118),P=0.001);the exposure time of X-ray was significantly shorter in the ultrasound group than in the X-ray group((31.3±7.9)s vs.(124.8±35.7)s,P<0.001),while the duration of ASP was longer in the ultrasound group((10.1±1.8)minutes vs.(8.2±1.3)minutes,P<0.001).In terms of complications,the incidence of puncture into the pericardium was lower in the ultrasound group(0 vs.3.4%(4/118),P=0.039);the rate of transient ST-segment elevation post ASP was sim

关 键 词：心房颤动 导管消融术 腔内超声检查 房间隔穿刺 

分 类 号：R541.75[医药卫生—心血管疾病]