环肺静脉电隔离量化消融损伤指标相关性研究  

A relevant study for diff erent quantitative indexes of ablation injury in circumferential pulmonary vein isolation

作　　者：王禹川[1] 黄波[1] 李康[2] 盛琴慧[2] 陈尔冬[2] 贺鹏康[2] 褚松筠[2] 蒋捷[2] 丁燕生[2] 周菁[2] WANG Yu-chuan;HUANG Bo;Li Kang;SHENG Qin-hui;CHEN Er-dong;HE Peng-kang;CHU Song-yun;JIANG Jie;DING Yan-sheng;ZHOU Jing(Department of Geriatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院老年科,北京100034 [2]北京大学第一医院心内科,北京100034

出　　处：《中国介入心脏病学杂志》2022年第7期530-534,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的确定与消融损伤指数(AI)值对应的时间-压力积分(FTI)值。方法对北京大学第一医院2020年7—9月40例首次接受环肺静脉电隔离的心房颤动(AF)患者消融数据进行分析。根据消融时间、导管-组织接触力(CF)和消融功率对消融损伤点分组,构建每组FTI预测AI的受试者工作特征(R OC)曲线。以ROC曲线下面积0.9为界值,对ROC曲线下面积≥0.9且每组消融损伤点数≥20的亚组数据进行分析并计算不同分组中与目标A I值相对应的FTI切点值。结果40例AF患者中阵发性AF 31例(77.5%),男28例(70.0%),平均年龄(67.1±5.4)岁。在剔除部分不满足入选条件的消融损伤点后,共纳入2747个消融损伤点,分为75个亚组。因进一步剔除不满足ROC曲线下面积≥0.9亚组的相关性数据,且考虑到亚组消融损伤点数过少会减弱数据分析的可信度,再将不足20个消融损伤点的亚组剔除,最终分析1948个消融损伤点、32个亚组。以左心房后壁线AI目标值400为例,消融功率25 W,CF在6~10 g、11~15 g、16~20 g和21~25 g时,FTI切点值分别为278 gs、275 gs、316 gs和348 gs;消融功率30 W,CF在6~10 g、11~15 g、16~20 g、21~25 g时,FTI切点值分别为183 gs、206 gs、235 gs和243 gs。对数据进一步分析后发现,在相同AI目标值和同一输出功率下,CF每增加5 g,对应的FTI目标值会增加约10%。如目标AI为400和输出功率为30 W时,11~15 g组FTI目标值较6~10 g组FTI目标值提高约10%,而16~20 g组FTI目标值较11~15 g组FTI目标值提高约10%。结论FTI值与AI值存在对应关系,但不同消融时间和CF对应的相同FTI值不具备等效性。Objective To determine the value of force-time integral(FTI),which got as equivalent effect of ablation injury as which guided by ablation index(AI).Methods Forty patients with atrial fibrilation(AF) referred to circumferential pulmonary vein isolation for the first time between July 2020 and September2020 in Peking University First Hospital were enrolled.The parameters related to each ablation injury in these patients were collected.Data were grouped according to ablation duration,contact force(CF) of catheter-tissue contact and ablation power In each group,a receiver operating characteristic curve(ROC) curve of correlation of FTI to AI was constructed.Taking 0.9 as the cut-off value of area under the ROC curve,the data in subgroups with cut-off value≥0.9 and amount of points of ablation injury≥20 were analyzed.Meanwhile,the cut-off value of FTI,which got as equivalent effect of ablation injury as injury produced by ablation guided by targeted AI value were calculated.Results Among these patients,the mean age was(67.1±5.4) years,including 28 males(70.0%) and 31(77.5%) with paroxysmal AF.There were 2 747 points of ablation injury in total.After screening according to the criteria,1 948 points of ablation injury and 32 subgroups were analyzed.Taking the AI target value of 400 in the posterior wall of the left atrium as an example,when the ablation power was 25 W and the CF was at 6-10 g,11-15 g,16-20 g,and 21-25 g,the FTI cut-point values were 278 gs,275 gs,316 gs and 348 gs,respectively.When ablation power of 30 W and CF at 6-10 g,11-15 g,16-20 g,21-25 g,FTI cutpoint values were 183 gs,206 gs,235 gs and 243 gs,respectively.After further analysis of the data,it was found that under the same AI target value and the same output power,for every 5 g increase in CF,the corresponding FTI target value would increase by about 10%.For example,when the target AI was 400 and the output power was 30 W,the FTI target value of the 11-15 g group is about 10% higher than that of the 6-10 g group,and the FTI target value of t

关 键 词：心房颤动 环肺静脉电隔离 消融损伤指数 时间-压力积分 

分 类 号：R541[医药卫生—心血管疾病]