心腔内超声心动图指导心房颤动一站式治疗初探  

The feasibility,efficacy and safety of one-stop treatment of atrial fibrillation guided by intracardiac echocardiography

作　　者：杜先锋[1] 冷冰 卓伟东 戚莹波 何斌[1] 丰明俊[1] 沈才杰[1] 刘晶[1] 傅国华[1] 俞理璞 王彬浩 高昉 储慧民[1] Du Xianfeng;Leng Bing;Zhuo Weidong;Qi Yingbo;He Bin;Feng Mingjun;Shen Caijie;Liu Jing;Fu Guohua;Yu Lipu;Wang Binhao;Gao Fang;Chu Huimin(Arrhythmia Center,Ningbo First Hospital,Ningbo 315010,China;Department of Cardiology,Mingzhou Hospital,Zhejiang University,Ningbo 315000,China)

机构地区：[1]宁波市第一医院心律失常诊疗中心,315010 [2]浙江大学明州医院心血管内科,宁波315000

出　　处：《中华心律失常学杂志》2021年第6期484-490,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：浙江省医药卫生科技计划项目(2020KY821)。

摘　　要：目的探索心腔内超声心动图(ICE)在指导心房颤动(房颤)一站式治疗中的可行性、有效性及安全性。方法连续入选宁波市第一医院2019年3月至2021年2月行房颤导管消融联合左心耳封堵一站式治疗的患者。其中不能耐受或不愿接受术中经食管超声心动图(TEE)指导的患者,采用ICE替代作为术中超声影像学工具(ICE组)并遵循"三轴六向法"的LOVE术式进行手术。与应用TEE患者(TEE组)比较,评估ICE指导房颤一站式治疗的成功率、围术期不良事件及随访结局。结果纳入172例行一站式治疗的房颤患者(男112例),年龄(68.8±7.9)岁,其中ICE组36例,TEE组136例。两组患者基线资料、联合手术策略、手术时间、术中即刻封堵成功率及完全封堵率相比均差异无统计学意义(P>0.05)。ICE组在房颤消融部分的X线曝光时间[(2.9±2.8)min对(5.0±3.6)min,P=0.002],左心耳封堵部分的X线曝光时间[(4.4±3.4)min对(7.2±3.6)min,P<0.001]、X线曝光量[(67.6±105.7)mGy对(149.1±139.0)mGy,P=0.001]及术中造影剂用量[(62.1±65.5)ml对(103.7±42.6)ml,P<0.001]均显著低于TEE组。术后平均随访(17.2±7.0)个月,两组无房颤复发成功率、术后封堵器残余分流、口服抗凝药停药率及安全性终点均差异无统计学意义(P>0.05)。ICE组实际观察到的缺血性卒中发生率为1.9/100患者年,与基于CHA2DS2-VASc评分预测的脑卒中事件发生率相比,减少77%的风险;ICE组观察到的实际出血事件发生率为3.9/100患者年,与基于HAS-BLED评分预测的出血事件发生率相比,减少32%的风险。结论ICE指导下的房颤一站式治疗可行、有效且安全,并可较传统TEE指导的一站式手术显著减少术中X线暴露及造影剂用量。Objective To investigate the feasibility,efficacy and safety of the combined procedure of left atrial appendage closure(LAAC)and atrial fibrillation(AF)catheter ablation under the intracardiac echocardiography(ICE)guidance.Methods Consecutive patients indicated for AF combined procedure between March 2019 and February 2021 were enrolled from Ningbo First Hospital.Procedures following the"Left atrial appendage closure workflow Via the intracarcliac Echocardiography guidance"(LOVE)workflow(ICE group)were performed in patients who were intolerant or contraindicated to the intra-procedural transesophageal echocardiography(TEE)assessment.Outcomes including AF-free success rates,peri-procedural complications and follow-up results were recorded and compared with patients who underwent combined procedures under the TEE guidance(TEE group).Results Thirty-six out of the 172 patients[112 male,(68.8±7.9)years old]were enrolled into the ICE group with the remainder in the TEE group.The baseline characteristics,combined strategies,procedural time,acute success rate of LAAC and percentage of complete closure were comparable between groups.The fluoroscopy time[(2.9±2.8)min vs.(5.0±3.6)min,P=0.002]in the AF ablation section,the fluoroscopy time[(4.4±3.4)min vs.(7.2±3.6)min,P<0.001]and exposure[(67.6±105.7)mGy vs.(149.1±139.0)mGy,P=0.001]plus the contrast volume[(62.1±65.5)ml vs.(103.7±42.6)ml,P<0.001]in the LAAC section were significantly lower in the ICE group.No difference was documented in AF-free success rate,peri-device leak,discontinuousness of oral anticoagulants and safety endpoints after(17.2±7.0)months follow-up(P>0.05).The observed annualized ischemic stroke and bleeding rates were 1.9 per 100 patient-years(100-PY)and 3.9 per 100-PY,respectively,referring 77%risk reduction of stroke compared to the expected rate from CHA2DS2-VASc score and 32%risk reduction of bleeding compared to the expected rate from HAS-BLED score.Conclusion Combined procedures of AF ablation and LAAC under the ICE guidance were proved fe

关 键 词：心房颤动 导管消融 左心耳封堵 心腔内超声心动图 一站式 

分 类 号：R541.75[医药卫生—心血管疾病]