三维心腔内超声引导下导管消融治疗房性快速性心律失常的疗效及安全性评价  

Evaluation of the efficacy and safety of catheter ablation guided by three-dimensional intracardiac ultrasound in the treatment of atrial tachyarrhythmia

作　　者：何蔺 郑曦 郭成 陈世蓉 刘涛 HE Lin;ZHEN Xi;GUO Cheng;CHEN Shirong;LIU Tao(Department of Cardiology,Nanchong Central Hospital,Nanchong 637003,China)

机构地区：[1]南充市中心医院心内科,637003

出　　处：《心肺血管病杂志》2024年第3期297-302,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：南充市市校科技战略合作专项(20SXQT0197)。

摘　　要：目的:探讨三维心腔内超声(intracardiac ultrasound,ICE)引导下导管消融治疗房性快速性心律失常的临床疗效及安全性。方法:回顾性选取88例房性快速性心律失常患者,所有患者均行导管射频消融(radiofrequency catheter ablation,RFCA)治疗,其中38例在术中应用ICE(观察组),50例术中未应用ICE(对照组)。对比两组的建模时间、房间隔穿刺时间、消融成功率、不良反应发生率等。结果:与对照组相比,观察组的建模时间、房间隔穿刺时间、左肺静脉消融时间、右肺静脉消融时间及X线曝光时间明显更短(P<0.05)。两组消融肺静脉各节段(后壁、底部、前壁、顶部和嵴部)的AI值比较,差异均无统计学意义(P>0.05)。观察组首次消融成功率为97.4%(37/38),对照组为82.0%(41/50),观察组的消融成功率显著高于对照组(P<0.05),并且观察组的随访复发率显著低于对照组(2.6%vs. 12.0%,P<0.05)。观察组的术中并发症总发生率显著低于对照组,差异有统计学意义(5.3%vs. 14.0%,P<0.05)。结论:三维ICE引导下对房性快速性心律失常行RFCA治疗,可有效提高消融成功率,缩短手术时间,减少X线暴露,并减少术中并发症发生风险。Objective:To explore the clinical efficacy and safety of three-dimensional intracardiac ultrasound(ICE)guided catheter ablation in the treatment of atrial tachyarrhythmia.Method:A total of 88 patients with atrial tachyarrhythmia were retrospectively selected,and all patients underwent radiofrequency catheter ablation(RFCA)treatment.Among them,38 patients received intraoperative use of ICE(observation group)and 50 patients did not receive intraoperative use of ICE(control group).The modeling time,atrial septal puncture time,ablation success rate,and incidence of adverse reactions were compared between the two groups.Results:Compared with the control group,the observation group had significantly shorter modeling time,atrial septal puncture time,left pulmonary vein ablation time,right pulmonary vein ablation time,and X-ray exposure time(P<0.05).There was no statistically significant difference in AI values between the two groups of ablated pulmonary vein segments(posterior wall,bottom,anterior wall,top,and crest)(P>0.05).The success rate of first ablation in t he observation group was 97.4%(37/38),while in the control group it was 82.0%(41/50).The success rate of ablation in the observation group was significantly higher than that in the control group(P<0.05).The recurrence rate during follow-up in the observation group was significantly lower than that in the control group(2.6%vs.12.0%,P<0.05).The total incidence of intraoperative complications in the observation group was significantly lower than that in the control group,with a statistically significant difference(5.3%vs.14.0%,P<0.05).Conclusions:RFCA treatment for atrial tachyarrhythmia guided by three-dimensional ICE can effectively improve the success rate of ablation,shorten surgical time,reduce X-ray exposure,and reduce the risk of intraoperative complications.

关 键 词：房性快速性心律失常 三维心腔内超声 消融指数 射频消融 

分 类 号：R54[医药卫生—心血管疾病]