单纯环肺静脉隔离与联合Marshall静脉化学消融对持续性心房颤动的疗效比较  

Comparison of the effects of pulmonary vein isolation alone and pulmonary vein isolation combined with Marshall venous chemical ablation on persistent atrial fibrillation

作　　者：刘涛 刘芃[1] 周益锋[1] 高瑞龙[1] 关振华[3] 罗斌 Liu Tao;Liu Peng;Zhou Yifeng;Gao Ruilong;Guan Zhenhua;Luo Bin(Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Cardiology,East Branch,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Baoding No.1 Central Hospital,Baoding 071000,China)

机构地区：[1]中日友好医院心脏科,北京100029 [2]河北医科大学第二医院东院区心内一科,石家庄050000 [3]保定市第一中心医院心内一科,保定071000

出　　处：《中华心律失常学杂志》2023年第1期15-20,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨环肺静脉隔离(PVI)基础上联合Marshall静脉化学消融治疗持续性心房颤动的安全性、有效性以及远期疗效。方法回顾性分析2018年12月至2020年12月于中日友好医院心脏科因持续性心房颤动首次行射频消融的120例患者,根据治疗策略分为单纯PVI组(PVI组,n=90),PVI+Marshall静脉化学消融组(Marshall组,n=30)。观察两组的手术时间、X线曝光量及术后6、12个月有无心房颤动/房性心动过速(房速)发作、手术并发症等。结果共纳入首次行射频消融的持续性心房颤动患者120例。PVI组年龄(55.4±7.4)岁,其中男72例(80.0%,72/90);Marshall组年龄(58.4±6.6)岁,其中男23例(76.7%,23/30)。①与PVI组相比,Marshall组二尖瓣峡部持久性损伤的成功率提高,也增加了手术时间[(150.3±30.7)min对(120.3±20.6)min,P<0.001]及X线曝光量[(180.3±45.7)mGy/cm^(2)对(50.3±25.5)mGy/cm^(2),P<0.001],差异均有统计学意义。②随访结果:Marshall组较PVI组术后未发作心房颤动/房速、维持窦性心律成功率高,差异均具有统计学意义[6个月:80.0%(24/30)对70.0%(63/90),P=0.013;12个月:76.7%(23/30)对64.4%(58/90),P=0.012]。③Marshall组与PVI组相比,两组并发症方面差异无统计学意义(P=0.057)。结论PVI联合Marshall静脉化学消融安全、有效,且可增加持续性心房颤动的远期成功率。Objective To evaluate the safety,efficacy and long-term effect of traditional pulmonary vein isolation(PVI)alone and PVI combined with Marshall vein ablation on persistent atrial fibrillation(PAF).Methods A retrospective analysis was made on 120 patients with PAF who underwent the first radiofrequency ablation for PAF in Department of Cardiology,China-Japan Friendship Hospital from December 2018 to December 2020.According to the treatment strategy,they were divided into two groups,namely isolated circumferential PVI alone group(PVI group,n=90),PVI combined with Marshall venous chemical ablation group(Marshall group,n=30).The operation time,X-ray exposure,the incidence of atrial fibrillation(AF)/atrial tachycardia(AT)and complications were compared between the two groups.Results A total of 120 patients were included[PVI group:mean age(55.4±7.4)years,72 in male(80.0%,72/90);Marshall group:mean age(58.4±6.6)years,23 in male(76.7%,23/30)].①PVI combined with Marshall venous chemical ablation increased the success rate of mitral isthmus injury,operation time[(150.3±30.7)min vs.(120.3±20.6)min,P<0.001]and X-ray fluoroscopy dose[(180.3±45.7)mGy/cm^(2) vs.(50.3±25.5)mGy/cm^(2),P<0.001].②During the follow-up period,the success rate of maintaining sinus rhythm in Marshall group was higher than that in PVI group[half a year:80.0%(24/30)vs.70.0%(63/90),P=0.013 and one year:76.7%(23/30)vs.64.4%(58/90),P=0.012].③There was no significant difference in complications between two groups(P=0.057).Conclusion PVI combined with Marshall venous chemical ablation can safely and effectively increase the long-term success rate of PAF.

关 键 词：心房颤动 肺静脉消融 Marshall静脉化学消融 二尖瓣峡部 

分 类 号：R541.75[医药卫生—心血管疾病]