心房颤动射频消融左、右侧环肺静脉电隔离顺序对手术的影响  

Effectof the sequence of left/right circumferential pulmonary vein isolationon intraoperationalvagal response and outcome in atrial fibrillationablation

作　　者：何利伟[1] 谢亮真 林之展 杨苗苗 黄兴福[1] 刘深荣 欧建延 彭健[1] Liwei He;Liangzhen Xie;Zhizhan Lin;Miaomiao Yang;Xingfu Huang;Liushen Rong;Jianyan Ou;Jian Peng(Department of Cardiology,Nanfang hospital of Southern Medical University 510515;Department of Geriatrics,nanfang hospital of southern medical university;Department of Cardiology,the first affiliated hospital of GuangzhouMedical University)

机构地区：[1]南方医科大学南方医院心血管内科,510515 [2]南方医科大学南方医院老年科 [3]广州医科大学第一附属医院心血管内科

出　　处：《岭南急诊医学杂志》2022年第6期518-520,527,共4页Lingnan Journal of Emergency Medicine

摘　　要：目的:探究心房颤动射频术中左、右侧肺静脉消融顺序对迷走反应发生率及疗效的影响。方法:连续纳入自2019年2月至2021年6月共142例诊断为房颤并于我院行射频治疗的患者。根据左、右肺静脉隔离顺序将分为两组:R组(n=70):先行右侧环肺静脉电隔离;L组(n=72):先行左侧环肺静脉电隔离。对比两组间总手术时间、总消融时间、术中迷走反应发生率及手术成功率。结果:术中L组共10例(10/72)发生低血压,而R组0例(0/70)发生,两组间低血压发生率存在统计学差异(P<0.05)。L组共23例(23/72)发生心脏停搏,而R组共5例(5/70),两组间心脏停搏发生率存在统计学差异(P<0.05)。L组平均手术时间显著长于R组[(155.11±27.54)min vs(141.59±26.18)min,P<0.05],两组间消融时间无统计学差异[(1521.54±389.66)s vs(1434.01±366.82)s,P>0.05]。两组所有患者均达到双侧肺静脉电隔离,平均随访(9.3±4.7)个月,L组共17例(17/72)、R组14例(14/70)复发(P>0.05)。结论:房颤射频消融术中,先行右侧环肺静电隔离可降低迷走反应的发生率、提高手术安全性,同时缩短手术总时间,提高手术效率。Objective:To investigate the effect of different sequence of left and right circumferential pulmonary vein isolation(CPVI)on vagal response and outcome in atrial fibrillation(AF)ablation.Methods:From February 2019to June 2021,142 consecutive patients diagnosed with AF and underwentablation were enrolled.The patients were divided into two groups:Group R(n=70):the right CPVI was performed first.Group L(n=72):the left CPVI was performed first.The operation parameters were compared.Results:Hypotension occurred in 10 cases(10/72)in Group L and 0cases(0/70)in Group R(P<0.01).Cardiac arrest occurred in 23 cases(23/72)in Group L and 5 cases(5/70)in Group R(P<0.01).The average operation time in Group L was significantly longer than that in Group R(155.11±27.54min vs 141.59±26.18 min P=0.003).There was no significant difference in ablation time between the two groups(1521.54±389.66 s vs 1434.01±366.82 s P=0.171).All patients achieved bilateral CPVI.Within 9.3±4.7 months followup,17 patients(17/72)in Group L and 14 patients(14/70)in Group R recurred(P=0.603).Conclusion:During AF ablation,right CPVI first can reduce the incidence of vagal reaction,improving the safety and shorten the total operation time,with no significant difference of the success rate.

关 键 词：心房颤动 心脏自主神经节丛 环肺静脉隔离术 消融顺序 迷走反应 

分 类 号：R541.75[医药卫生—心血管疾病]