冷冻球囊消融与射频消融对阵发性心房颤动患者心房重构的影响  

The effect of cryoballoon ablation or radiofrequency ablation on left atrial remodeling in patient with paroxysmal atrial fibrillation

作　　者：王徐乐[1] 宋贝贝 王玺[1] 陈英伟[1] 陈晓杰[1] 卢文杰[1] 李然[1] 韩战营[1] 邱春光[1] WANG Xule;SONG Beibei;WANG Xi;CHEN Yingwei;CHEN Xiaojie;LU Wenjie;LI Ran;HAN Zhanying;QIU Chunguang(Department of Cardiology,The 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内科,郑州450052

出　　处：《临床心血管病杂志》2022年第1期54-58,共5页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81600271)。

摘　　要：目的:比较冷冻球囊消融(CBA)与射频消融(RFA)对阵发性心房颤动(房颤)患者心房重构的影响。方法:本研究选取在2014年5月-2017年5月于郑州大学第一附属医院因阵发性房颤行CBA或RFA治疗的患者。所有患者均于术前、术后半年、1年、2年和3年时行12导联心电图或24 h动态心电图和超声心动图检查。左心房电重构通过P波离散度(Pdis)进行评估,结构重构通过左心房直径(LAD)和左心房容积指数(LAVI)评估。结果:共入选328例患者,经过倾向性评分法匹配后,CBA组和RFA组分别纳入96例患者。消融术后1年、2年和3年,CBA组与RFA组患者的Pdis、LAD和LAVI均较术前明显减小(P<0.05);且消融术后6个月、1年、2年和3年,CBA组患者的Pdis、LAD和LAVI均较RFA组更小(P<0.05)。Logistic回归分析发现,患者消融术后1年时的ΔPdis、ΔLAD或ΔLAVI是房颤/心房扑动(房扑)发生的独立危险因素(OR=1.307,95%CI 1.039~1.605,P=0.035;OR=1.301,95%CI 1.089~1.522,P<0.001;OR=1.879,95%CI 1.711~1.963,P<0.001)。结论:CBA和RFA均可有效改善阵发性房颤患者的左心房电重构和结构重构,且CBA组患者左心房逆重构可能较RFA组更明显。Objective: The purpose is to assess the effect of atrial remodeling in patients with paroxysmal AF after CBA and RFA. Methods: We enrolled 328 patients who underwent CBA or RFA for refractory paroxysmal AF in May 2014-May 2017. Patients were asked to undergo a 12-lead electrocardiogram, a 24-h Holter monitor, and an echocardiogram and to provide their clinical history and symptoms at 6 months and 1, 2, and 3 years postprocedurally. Electrical remodeling of the left atrium was assessed by P wave dispersion(Pdis);structural remodeling was assessed by theleft atrium diameter(LAD) and left atrial volume index(LAVI) during scheduled visits. Results: After propensity score matching, 96 patients were included in the CBA group, and 96 were included in the RFA group. As of January 2020, compared with baseline, at 1 year, 2 years and 3 years after ablation, the average changes in Pdis(ΔPdis), LAD(ΔLAD) and LAVI(ΔLAVI) were significant in both the CBA and RFA groups(P<0.05). Six months after ablation, ΔPdis, ΔLAD and ΔLAVI were greater in the CBA group than in the RFA group(P<0.05). A higher ΔPdis, ΔLAD or ΔLAVI at 1 year after ablation may increase atrial fibrillation/flutter-free survival. Conclusion: Although CBA and RFA are both effective in left atrial electrical and structural reverse-remodeling in paroxysmal AF, CBA may outperform RFA six months after ablation.

关 键 词：心房颤动 心房重构 冷冻球囊消融 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]