心腔内超声辅助心房颤动患者射频消融治疗的观察  

Observation of radiofrequency ablation in patients with atrial fibrillation assisted by intracardiac echocardiography

作　　者：王宇[1] 邹艾霖 孙铃[1] 纪元[1] WANG Yu;ZOU Ai-lin;SUN Ling;JI Yuan(Department of Cardiology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213000,Jiangsu,China)

机构地区：[1]南京医科大学附属常州市第二人民医院心内科,江苏常州213000

出　　处：《中国心脏起搏与心电生理杂志》2023年第5期410-414,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨心腔内超声(ICE)引导下的心房颤动(简称房颤)消融的可行性及安全性。方法采用前瞻性队列研究方法,选择2021年6月至2022年6月收治的房颤患者作为研究对象。根据手术中是否使用ICE引导分为ICE组和X线组,比较两组患者的一般资料、临床基线特征及手术数据。结果ICE组共入组34例,X线组共283例,与X线组比较,ICE组卒中和阵发性房颤比例大(P<0.05或0.001);血浆脑钠肽高、左房内径大,而左室射血分数低(P均<0.001);而其他一般资料和临床基线特征均无显著差异(P均>0.05)。与X线组比较,ICE组房间隔穿刺时间、X线曝光时间、肺静脉隔离时间明显缩短,分别为[(5.59±2.58)minvs(7.44±3.54)min,(275.56±80.69)svs(362.10±157.08)s,(1.38±0.37)hvs(2.57±0.98)h,P<0.05或0.001]。两组手术均未发生严重并发症。由于ICE组与X线组人数相差较大,故以年龄、性别、房颤类型、左房内径、左室射血分数为标准按倾向评分0.02进行1∶1匹配,ICE组(n=33)X线曝光时间[(274.48±81.70)min]仍较X线组(n=29)[(469.97±252.07)min]更短(P<0.001),肺静脉隔离的时间[(1.37±0.36)hvs(2.97±1.19)h]更短(P<0.001),但两组之间房间隔穿刺时间无明显差异(P=0.227)。结论心超内超声引导下消融治疗房颤X线曝光时间短,肺静脉隔离时间短,而手术安全有效。Objective To investigate the feasibility and safety of intracardiac echocardiography(ICE)guided ablation of atrial fibrillation(AF).Methods A prospective cohort study was used to select patients with atrial fibrillation who were admitted between June 2021 and June 2022.According to whether or not to use in the operation guide into ICE group and X-ray group,and compare the two group of patients with general information,clinical baseline characteristics and the operation data.Results A total of 34 patients were enrolled in the ICE group and 283 in the X-ray group.Compared with the X-ray group,the incidence of stroke and paroxysmal AF was higher in the ICE group(P<0.05 or 0.001);Plasma brain natriuretic peptide was higher,left atrial diameter was larger,and left ventricular ejection fraction(LVEF)was lower(P<0.001);There were no significant differences in other general data and clinical baseline characteristics(P<0.05).Compared with the X-ray group,the interatrial puncture time,X-ray exposure time and pulmonary vein isolation time in the ICE group were significantly shortened[respectively(5.59±2.58)min vs(7.44±3.54)min and(275.56±80.69)s vs(362.10±157.08)s,(1.38±0.37)h vs(2.57±0.98)h,P<0.05 or 0.001].No serious complications occurred in the two groups.Due to the large difference in the number of people between the ICE group and the X-ray group,1∶1 matching was performed based on the criteria of age,gender,type of AF,left atrial diameter and LVEF according to the tendency score 0.02.The time of X-ray exposure[(274.48±81.70)min]in the ICE group(n=33)was still shorter than that in the X group(n=29)[(469.97±252.07)min](P0.001),and the time of pulmonary vein isolation[(1.37±0.36)h vs(2.97±1.19)h]was shorter(P<0.001),but there was no significant difference in atrial septal puncture time between the two groups(P=0.227).Conclusion The X-ray exposure time and pulmonary vein isolation time are short in the treatment of AF guided by ICE,and the operation is safe and effective.

关 键 词：心血管病学 心房颤动 射频消融 低量射线 极低量射线 心腔内超声 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学] R540.45[医药卫生—临床医学]