肺静脉电隔离加左房后壁BOX消融对持续性心房颤动的疗效  

Efficacy of enlarged BOX ablation for persistent atrial fibrillation:a 2-year single-center result

作　　者：种甲[1] 陈浩[1] 刘俊鹏[1] 吕游[1] 林高峰 佟佳宾[1] 施海峰[1] CHONG Jia;CHEN Hao;LIU Jun-peng;LV You;LIN Gao-feng;TONG Jia-bin;SHI Hai-feng(Cardiovascular Medicine Department,Bei-jing Hospital,Beijing 100730,China)

机构地区：[1]北京医院心血管内科,北京100730

出　　处：《中国心脏起搏与心电生理杂志》2022年第2期129-133,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 评估消融指数指导下扩大的左房后壁BOX消融在持续性心房颤动(简称房颤)中的效果和安全性。方法 连续性纳入北京医院自2016年7月至2020年1月因症状性持续性房颤接受左房后壁BOX消融且年龄≥18岁的患者46例,在消融指数指导下行双侧肺静脉电隔离+扩大的左房后壁BOX消融,并进行长期随访。结果 46例全部实现双侧肺静脉电隔离。42例具有隔离验证结果的患者中有36例(85.7%)实现左房后壁电隔离。20例(43.5%)患者在(24.2±11.1)个月的随访过程中复发,第6、12、24个月的无房性心律失常率分别为80%、70.7%和52%,术中发生需要引流的心包积液1例;术后有2例需要干预的穿刺部位血肿,围术期无死亡、心房食管瘘、肺静脉狭窄及栓塞事件发生。长程持续性房颤是术后复发的独立危险因素(P=0.006),而β受体阻滞剂(P=0.023)和术中实现后壁电隔离(P=0.009)是复发的保护性因素。结论 消融指数指导下的肺静脉隔离联合扩大的左房后壁隔离术治疗持续性房颤的2年无房性心律失常生存率超过50%且安全性良好。Objective To evaluate the efficacy and safety of enlarged BOX ablation guided by ablation index in persistent atrial fibrillation. Methods From July 2016 to January 2020, patients aged 18 years or older who underwent left atrial posterior wall box ablation due to symptomatic persistent atrial fibrillation in Beijing hospital were enrolled in this study. Results Bilateral pulmonary vein isolation was achieved among all 46 patients underwent enlarged left atrial posterior wall box ablation. Among the 42 patients with isolation verification results, 36(85.7%) achieved electrical isolation of the left atrial posterior wall. Twenty patients(43.5%) recurred during the follow-up period of(24.2±11.1) months. The atrial arrhythmia free survival rates at 6, 12, and 24 months were 80%, 70.7%, and 52%, respectively. Long-standing persistent atrial fibrillation was an independent risk factor for postoperative recurrence(P=0.006), while beta-blockers(P=0.023) and intraoperative posterior wall isolation(P=0.009) were protective factors for recurrence. Conclusion Ablation index guided pulmonary vein isolation combined with enlarged BOX ablation has a 2-year atrial arrhythmia free survival rate of more than 50% and good safety profile in persistent atrial fibrillation.

关 键 词：心血管病学 心房颤动 射频消融 心房重构 后壁隔离 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]