心房颤动患者冷冻球囊消融术后肺静脉狭窄的影响因素分析  

Risk Factors for Pulmonary Vein Stenosis in Patients With Atrial Fibrillation After Cryoballoon Ablation

作　　者：夏雨 王凤阳 丁立刚[1] 孙奇[1] 刘俊[1] 牛国栋[1] 吴灵敏[1] 郑黎晖[1] 马坚[1] 方丕华[1] 姚焰[1] XIA Yu;WANG Fengyang;DING Ligang;SUN Qi;LIU Jun;NIU Guodong;WU Lingmin;ZHENG Lihui;MA Jian;FANG Pihua;YAO Yan(Cardiac Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Songyuan Central Hospital,Songyuan 138001,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常诊治中心,北京100037 [2]松原市中心医院心内科,松原138001

出　　处：《中国循环杂志》2023年第4期427-433,共7页Chinese Circulation Journal

摘　　要：目的:探讨心房颤动(房颤)患者冷冻球囊消融(CBA)术后肺静脉狭窄(PVS)的发生率及其影响因素。方法:连续入选2015年6月至2021年1月于中国医学科学院阜外医院首次行CBA且于术前和术后均接受了左心房肺静脉CT血管造影的患者129例。使用Carto3 V6系统测量肺静脉口部面积(APVO)。根据APVO减小率(ΔAPVO)分为轻度(25%~50%)、中度(50%~75%)和重度(≥75%)PVS。将ΔAPVO≥25%的患者分为PVS组(n=41),ΔAPVO<25%的患者分为非PVS组(n=88)。结果:129例患者的平均年龄(60.30±9.83)岁,其中男性98例(76.0%)。共有41例(31.8%)患者出现PVS(共60支),其中轻度PVS 52支(86.7%)。CBA术后,左上、左下、右上和右下肺静脉的APVO分别减小了(37.5±103.0)mm^(2)(P<0.01)、(37.3±93.7)mm^(2)(P<0.01)、(59.8±112.0)mm^(2)(P<0.01)和(38.3±87.0)mm^(2)(P<0.01)。多因素Logistic回归分析发现,术前APVO(OR=1.002,95%CI:1.001~1.007,P<0.05)和术中最低冷冻温度(OR=0.939,95%CI:0.748~0.987,P<0.05)与CBA术后各支肺静脉发生PVS独立相关。结论:房颤患者CBA术后PVS发生率较高,以轻度PVS为主。术前APVO较大和术中最低冷冻温度较低与PVS风险增加相关。Objectives:Pulmonary venous stenosis(PVS)is one of the severe and easily ignored complications after atrial fibrillation(AF)cryoballoon ablation(CBA).This study investigated the incidence of PVS in patients with AF after CBA and its risk factors.Methods:Consecutive patients who underwent CBA for AF for the first time and underwent left atrial CT angiography pre-and post-operation in Fuwai Hospital from June 2015 to January 2021,were enrolled.Area of pulmonary vein orifice(APVO)was measured using the Carto3 V6 system.According to the reduction rate of APVO(ΔAPVO),PVS was classified into mild(25%-50%),moderate(50%-75%)and severe(≥75%).Patients withΔAPVO≥25%were assigned into PVS group(n=41),while those withΔAPVO<25%were assigned into non-PVS group(n=88).Results:A total of 129 patients were included in this study,average age was(60.30±9.83)years old,and 98 patients(76.0%)were male.PVS was diagnosed in 41(31.8%)patients,and 86.7%was mild PVS.Post CBA,the APVO of left superior pulmonary vein,left inferior pulmonary vein,right superior pulmonary vein and right inferior pulmonary vein decreased by(37.5±103.0)mm^(2)(P<0.01),(37.3±93.7)mm^(2)(P<0.01),(59.8±112.0)mm^(2)(P<0.01)and(38.3±87.0)mm^(2)(P<0.01),respectively.Multivariate logistic regression analysis showed that preoperative APVO(OR=1.002,95%CI:1.001-1.007,P<0.05)and intraoperative freezing nadir(OR=0.939,95%CI:0.748-0.987,P<0.05)were independently associated with PVS in each pulmonary vein after CBA.Conclusions:Patients with AF face a high incidence of PVS after CBA,but most patients had mild PVS.Larger preoperative APVO and lower intraoperative freezing nadir are associated with an increased risk of PVS after CBA.

关 键 词：心房颤动 冷冻球囊消融 计算机断层血管造影 肺静脉狭窄 

分 类 号：R54[医药卫生—心血管疾病]