起搏联合三磷酸腺苷注射法强化肺静脉电隔离对阵发性心房颤动消融术后成功率的影响  

The impact of enhanced pulmonary vein isolation on the long-term success rate after ablation in patients with paroxysmal atrial fibrillation:a combination of pacing and adenosine triphosphate injection

作　　者：陈建华[1] 陈泉河 张飞龙[1] 陈学海[1] 许哲[1] 江琼[1] 孙旭东[1] 李金国[1] 陈良龙[1] 王伟伟[1] CHEN Jian-hua;CHEN Quan-he;ZHANG Fei-long;CHEN Xue-hai;XU Ze;JIANG Qiong;SUN Xu-dong;LI Jin-guo;CHEN Liang-long;WANG Wei-wei(Department of Cardiology,Fujian Medical University Union Hospital,Fujian Institute of Coronary Disease,Fujian Heart Medical Center,Fuzhou 350001,Fujian,China;Fujian Medical University Union Clinic Medical College)

机构地区：[1]福建医科大学附属协和医院心内科,福建省冠心病研究所,福建省心脏医学中心,福建福州350001 [2]福建医科大学协和临床学院

出　　处：《中国心脏起搏与心电生理杂志》2021年第3期239-244,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：福建省科技厅面上项目(2017Y0039)。

摘　　要：目的探讨在首次肺静脉电隔离术(PVI)后,采用起搏夺获+静脉注射三磷酸腺苷(ATP)+补充消融的强化PVI的术式能否减少PVI术后心房颤动(简称房颤)的复发率,并评价手术的安全性以及术后左房结构及功能的变化。方法采用前瞻性随机研究设计,纳入2017年3月1日至2018年12月31日在福建医科大学附属协和医院心内科诊断阵发性房颤拟行经导管射频消融治疗的病人,随机分为两组:A组:采用首次PVI后观察30min+补充消融的术式;B组:采用首次PVI后观察30 min+起搏夺获+静脉注射ATP+补充消融的术式。比较两组病人术后12个月房颤的复发率,术后左房结构及功能的变化的有关指标。结果 A组128例,在首次PVI后观察30 min,在54/128(42.2%)例中,发现有157/525(29.9%) PVs-LA之间恢复电传导;B组138例,在首次PVI后共有120/138(87.0%)例的365/562(64.9%) PVs-LA之间电传导恢复。术后随访12个月,A组有25例(19.5%)、B组有15例(10.9%)复发房颤(P=0.048)。B组术后12个月时左房、左室后壁厚度以及室间隔厚度均明显小于术前(P值均<0.001);肺动脉压力较术前明显降低(P=0.004);左室射血分数较术前明显升高(P=0.002)。结论射频消融治疗阵发性房颤,在首次PVI后,采用观察30 min+起搏夺获+静脉注射ATP+补充消融的强化PVI术式,可以减少PVI术后远期房颤的复发率,还可以改善术后12个月时左房和左室的结构及功能。Objective To investigate whether the enhanced pulmonary vein(PV) isolation(PVI) of complete eli mination of pulmonary vein reconnection induced by pacing capture and adenosine triphosphate injection can reduce the long-term recurrence rate of atrial fibrillation(AF),and the changes of the left atrial structure and function. Methods This was an open-label, prospective, randomized study.Patients with paroxysmal AF were randomly divided into two groups: Group A,complete eli mination of PV reconnection induced by time at 30 minutes after the first PVI.Group B,complete eli mination of PV reconnection induced by time, pacing capture and adenosine triphosphate injection after the first PVI.The recurrence rate of AF at 12 months after ablation was compared between the two groups, and the changes of left atrial structure and function were evaluated. Results After the first PVI,PV reconnection were found in 157 of total 525 PVs(27.9%) in 54 of total 128 patients(42.2%) in group A,and in 365 of total 562 PVs(64.9%) in 120 of total 138 patients(87.0%) in group B.All of the PV reconnection were eli minated successfully.After 12 months follow-up, 25 patients(19.5%) in group A and 15 patients(10.9%) in group B had recurrent AF(P =0.048).Compared with group B,the recurrent rate of AF was significant higher in group A,Patients in group B,at 12 months after ablation,the size of left atrial,the thickness of left ventricular posterior wall and intraventricular septumwas significant lower(P<0.001).Similarly,the mean pulmonary artery pressure was significant lower(P=0.004),the left ventricular ejection fraction was significantly higher(P=0.002). Conclution Radiofrequency catheter ablation is an effective treatment in patients with paroxysmal AF.Enhanced PVI of complete eli mination of PV reconnection induced by 30-minute-oberservation,pacing capture and adenosine triphosphate injection can reduce the longterm recurrence rate of AF,but also improve the structure and function of the left atrium and ventriculum at 12 months after PVI.[Ch

关 键 词：心血管病学 心房颤动 射频消融 起搏 腺苷 

分 类 号：R541.7+5[医药卫生—心血管疾病] R318.11[医药卫生—内科学]