肺静脉解剖变异对持续性心房颤动患者冷冻消融疗效的影响  

Influence of pulmonary vein anatomical variations on cryoablation efficacy in patients with persistent atrial fibrillation

作　　者：郑杰 刘晓宇 尤华彦 李库林 赵晓溪 王如兴 ZHENG Jie;LIU Xiaoyu;YOU Huayan;LI Kulin;ZHAO Xiaoxi;WANG Ruxing(Department of Cardiology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院心内科,江苏无锡214023

出　　处：《实用心电学杂志》2024年第2期109-113,共5页Journal of Practical Electrocardiology

基　　金：国家自然科学基金资助项目(82000317,82370342);无锡市双百中青年医疗卫生拔尖人才资助项目(BJ2023006)。

摘　　要：目的评估肺静脉解剖变异对持续性心房颤动(简称房颤)患者冷冻消融疗效的影响。方法回顾性分析98例接受冷冻球囊导管消融的持续性房颤患者的临床资料,按是否存在肺静脉变异将患者分为肺静脉变异组(21例)及非肺静脉变异组(77例)。比较两组患者的手术时间、放射暴露时长及剂量、术中并发症、手术成功隔离率以及各项随访指标。结果与非静脉变异组相比,肺静脉变异组消融手术时间[(35.1±13.4)min vs.(64.3±17.7)min]和放射暴露时长[(22.3±5.8)min vs.(33.6±6.0)min]均明显延长(P均<0.01),放射暴露CD值[(607.1±212.9)mGy vs.(1018.5±280.8)mGy]显著增加(P<0.01)。非静脉变异组一次隔离成功率明显高于静脉变异组(75/77 vs.16/21,P=0.01),但两组手术结束时肺静脉隔离均100%完成。随访一年时两组复发率间的差异无统计学意义(19/77 vs.6/21,P=0.726)。结论对于肺静脉变异的持续性房颤患者,冷冻消融治疗的急性期及长期成功率与非肺静脉变异患者相似。但肺静脉变异患者手术时间延长,且放射暴露增加。Objective To evaluate the impact of pulmonary vein anatomical variations on the efficacy of cryoablation in patients with persistent atrial fibrillation.Method A retrospective analysis was conducted on the clinical data of 98 patients with persistent atrial fibrillation who had undergone cryoballoon ablation.According to the presence or absence of pulmonary vein variations,they were divided into pulmonary vein variation group(variants group,21 cases)and non-pulmonary vein variation group(normal group,77 cases).The procedure time,duration and dose of X-ray exposure,intraoperative complications,procedure success rate of isolation,and each follow-up index were compared between the two groups.Results Compared with the normal group,the ablation procedure time[(35.1±13.4)min vs.(64.3±17.7)min]and X-ray exposure time[(22.3±5.8)min vs.(33.6±6.0)min]of the variants group were both longer(P<0.01)while the CD value of radiation exposure[(607.1±212.9)mGy vs.(1018.5±280.8)mGy]significantly increased(P<0.01).In the normal group,the success rate of primary isolation was significantly higher than that in the variants group(75/77 vs.16/21,P=0.01).However,both groups completed pulmonary vein isolation 100%at the end of procedure.The recurrence rate of the two groups did not vary significantly during one-year follow-up(19/77 vs.6/21,P=0.726).Conclusion For patients with persistent atrial fibrillation and pulmonary vein variations,the acute-stage and long-term success rates of cryoablation are similar to the rates in the patients without pulmonary vein variation.However,patients with pulmonary vein variations have prolonged procedure time and increased radiation exposure.

关 键 词：心房颤动 冷冻消融 肺静脉变异 放射暴露 

分 类 号：R541.71[医药卫生—心血管疾病]