上腔静脉隔离在导管消融治疗阵发性心房颤动中的效果及预后  

Effect and Prognosis of Superior Vena Cava Isolation in Catheter Ablation for Paroxysmal Atrial Fibrillation

作　　者：董淑娟[1] 崔路乾 李静超[1] 韩永梅 楚英杰[1] DONG Shujuan;CUI Luqian;LI Jingchao;HAN Yongmei;CHU Yingjie(Department of Cardiology,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心内科,河南郑州450003

出　　处：《河南医学研究》2021年第27期5003-5006,共4页Henan Medical Research

基　　金：河南省卫生厅重点科技攻关项目(122102310068)。

摘　　要：目的评价上腔静脉隔离(SVCI)在导管消融治疗阵发性心房颤动(房颤)中的有效性与安全性。方法本研究纳入112例接受导管消融治疗的阵发性心房颤动患者,均行环肺静脉隔离(CPVI)。PVI组(59例)仅在SVC起源房颤时行SVCI;PVI+SVCI组(53例)行经验性SVCI。比较两组患者的手术时间、X线曝光量、并发症及房颤复发情况,并分析影响房颤复发的预测因素。结果两组患者在手术时间、X线曝光量方面比较,差异无统计学意义(P>0.05),且均未发生窦房结损伤和隔神经损伤。两组患者首次导管消融后房颤复发情况比较,差异无统计学意义(P>0.05)。左房内径(HR=1.264,95%CI:1.069~1.494,P=0.006)、早期复发(HR=3.837,95%CI:1.029~14.302,P=0.045)是房颤复发的独立危险因素。结论SVCI在技术上是安全可行的。除CPVI外,行经验性SVCI不能显著提高阵发性心房颤动首次导管消融的成功率。左房内径、早期复发是影响房颤复发的独立预测因素。Objective To evaluate the efficacy and safety of superior vena cava isolation(SVCI)in catheter ablation of paroxysmal atrial fibrillation.Methods A total of 112 patients with paroxysmal atrial fibrillation who received catheter ablation were enrolled in this study.All patients underwent circumferential pulmonary vein isolation(CPVI).SVCI were underwent only if SVC-originated atrial fibrillation in PVI group(59 cases),while empirical SVCI were underwent in PVI+SVCI group(53 cases).The operation time,X-ray exposure,complications and recurrence of AF were compared between the two groups,and the predictive factors of atrial fibrillation recurrence were analyzed.Results There were no differences in procedural time and X-ray exposure between the two groups,and neither sinus node injury nor any injury to the phrenic nerve was observed in both groups.There was no difference in atrial fibrillation recurrence between the two groups after first procedure.Left atrial diameter(HR=1.264,95%CI:1.069-1.494,P=0.006)and early recurrence(HR=3.837,95%CI:1.029-14.302,P=0.045)were independent risk factors for the recurrence of atrial fibrillation.Conclusion SVCI is technically safe and feasible.An empiric SVCI in addition to the CPVI does not improve the success rate of the first Catheter ablation of paroxysmal atrial fibrillation.Left atrial diameter and early recurrence were independent risk factors for the recurrence of atrial fibrillation.

关 键 词：电生理学 心房颤动 导管消融 上腔静脉隔离 

分 类 号：R541.7[医药卫生—心血管疾病]