心房颤动导管消融术前食管造影对消融策略及预防食管损伤的价值研究  

Value of esophagography before catheter ablation for atrial fibrillation in ablation strategy and prevention of esophageal injury

作　　者：刘飞 朱业 顾翔 Liu Fei;Zhu Ye;Gu Xiang(Department of Cardiovascular Diseases,Jiangdu District People's Hospital of Yangzhou,Yangzhou225001,Jiangsu Province,China)

机构地区：[1]扬州市江都人民医院心血管内科,225001 [2]苏北人民医院心血管内科

出　　处：《中华老年心脑血管病杂志》2023年第6期588-592,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81800250);中国博士后科学基金(2022M711417)。

摘　　要：目的采取术前心脏CT检查评估食管与左心房、肺静脉的解剖关系,优化心房颤动(房颤)导管消融安全策略,最大限度减少食管损伤。方法选择2019年1月至2021年10月苏北人民医院心血管内科首次行射频导管消融和冷冻球囊消融术的老年房颤患者118例,所有患者成功行术前食管造影和心脏增强CT检查,左侧型102例,非左侧型16例。按照消融方式不同分为射频消融组86例和冷冻消融组32例。随访观察食管损伤相关症状的发生情况。结果食管前壁距离左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉分别为(12.20±6.55)mm、(7.13±3.32)mm、(24.10±9.72)mm、(18.10±8.35)mm,其与左下肺静脉距离最近,有统计学差异(P<0.05)。下肺静脉水平食管与左心房后壁接触宽度为(18.12±4.54)mm。左侧型与非左侧型患者食管距离左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉比较,有统计学差异(P<0.01)。射频消融组左侧型与非左侧型患者食管距离左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉比较,有统计学差异(P<0.05,P<0.01);冷冻消融组左侧型与非左侧型患者食管距离左下肺静脉、右上肺静脉、右下肺静脉比较,有统计学差异(P<0.01)。随访期间,发生反酸、嗳气、胸骨后或上腹疼痛等不同程度的食管损伤相关临床症状29例(24.6%),无食管心房瘘发生。结论心脏增强CT成像三维重建,更能充分展示食管、左心房、肺静脉的空间结构,这对合理选择消融方式、消融靶点等至关重要。Objective To evaluate the anatomical relationship in the esophagus,left atrium and pulmonary vein with preoperative cardiac CT scanning in order to optimize the safety strategy of catheter ablation for atrial fibrillation(AF)and minimize esophageal injury.Methods A total of 118 elderly AF patients who underwent radiofrequency catheter ablation and cryoablation for the first time in the Department of Cardiovascular Diseases of Northern Jiangsu People's Hospital from January 2019 to October 2021 were recruited in this study.All patients received preoperative esophagography and contrast-enhanced cardiac CT examination.Of them,102 cases were left type,and 16 cases were non-left type.The patients were divided into radiofrequency ablation group(n=86)and cryoablation group(n=32)according to different ablation methods.The occurrence of esophageal injury-related symptoms was followed up.Results The distances from the anterior esophageal wall to the left superior pulmonary vein,to left inferior pulmonary vein,to right superior pulmonary vein and to right inferior pulmonary vein were 12.20±6.55 mm,7.13±3.32 mm,24.10±9.72 mm and 18.10±8.35 mm,respectively,and the distance was the shortest to the left inferior pulmonary vein than to other veins(P<0.05).The contact width between the esophagus and left atrial posterior wall at the level of inferior pulmonary vein was 18.12±4.54 mm.Statistical differences were found in the distances to left superior pulmonary vein,to left in-ferior pulmonary vein,to right superior pulmonary vein,and to right inferior pulmonary vein between the left type and non-left type patients(P<0.01).There were significant differences in the above 4 distances between the left type and non-left type patients in the radiofrequency ablation group(P<0.05,P<0.01).In the cryoablation group,obvious differences were only seen in the distances to the left inferior pulmonary vein,to right superior pulmonary vein and to right inferior pulmonary vein between the left type and non-left type patients(P<0.01).During t

关 键 词：心房颤动 导管消融术 成像 三维 食管 

分 类 号：R541.75[医药卫生—心血管疾病]