三维标测系统封堵软件在心房颤动冷冻消融中的评估价值  

Evaluation value of three-dimensional mapping system occlusion software in cryoablation of atrial fibrillation

作　　者：李超 廖志勇 张道良 彭文杰 李华龙 赵亚楠 李腾 李宜富 颜红兵 姚焰 Li Chao;Liao Zhiyong;Zhang Daoliang;Peng Wenjie;Li Hualong;Zhao Yalan;Li Teng;Li Yifu;Yan Hongbing;Yao Yan(Center of Arrhythmia,Fuwai Shenzhen Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College.Shenzhen 518057,China;Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,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、心血管疾病国家重点实验室、阜外深圳医院心律失常中心,深圳518057 [2]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院心律失常中心,北京100037

出　　处：《中华心律失常学杂志》2024年第3期206-211,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：深圳市"医疗卫生三名工程"(SZSM201911017)。

摘　　要：目的探讨新型三维标测系统(KODEX-EPD)在心房颤动(房颤)患者冷冻消融过程中评估肺静脉封堵的可行性和准确性。方法本文为前瞻性队列研究。连续入选2022年1月至2022年7月中国医学院科学院阜外医院深圳医院接受房颤冷冻消融手术的阵发性或持续性房颤患者,收集患者临床资料以及术中收集分别使用基线法、注射法和肺静脉造影评估静脉完全封堵、小泄漏及大泄漏的肺静脉根数以传统肺静脉造影作为评估肺静脉封堵效果的金标准,对比评价三维标测系统(KODEX-EPD)封堵软件中基线法、注射法评估肺静脉封堵的敏感度和特异度。结果共纳入43例患者,其中男31例,年龄(59.05±12.17)岁。基线法评估肺静脉封堵的敏感度为92.3%(95%CI 82.3%~97.1%),特异度为44.1%(95%CI 32.3%~56.6%),阳性预测值为61.2%(95%CI 50.8%~70.7%),阴性预测值为85.7%(95%CI 68.9%~94.6%);注射法评估肺静脉封堵的敏感度为89.4%(95%CI 80.4%~94.7%),特异度为80%(95%CI 69.6%~87.6%),阳性预测值为81.7%(95%CI 72.1%~88.7%),阴性预测值为88.3%(95%CI 78.5%~94.2%)。结论三维标测系统(KODEX-EPD)封堵软件在房颤冷冻消融中评估肺静脉封堵效果,具有较好的敏感度和特异度。相对于基线法,注射法与肺静脉造影在评估肺静脉封堵的一致性更高。Objective To exploring the feasibility and accuracy of a novel three-dimensional mapping system(KODEX-EPD)for evaluating pulmonary vein occlusion during cryoablation in patients with atrial fibrillation(AF).Methods It was a prospective cohort study.The patients with paroxysmal or persistent AF who underwent cryoablation at Fuwai Shenzhen Hospital between January 2022 and July 2022 were selected.Clinical data,the number of pulmonary vein branches with complete occlusion,small leak and severe leak verified using the baseline method,injection method,and pulmonary venography during cryoablation were collected.Traditional pulmonary venography was used as the gold standard to evaluate the effect of PV occlusion,the feasibility and accuracy of three-dimensional mapping system(KODEX-EPD)occlusion tool software(including baseline method and injection method)in assessing PV occlusion were compared by contrast medium injection in each PV.Results A total of 43 patients(male in 31,female in 12)were included,with mean age of(59.05±12.17)years.The occlusion tool software of baseline method showed a 92.3%(95%CI 82.3%-97.1%)sensitivity and 44.1%(95%CI 32.3%-56.6%)specificity in assessing a complete PV occlusion,the positive predictive value was 61.2%(95%CI 50.8%-70.7%)and the negative predictive value was 85.7%(95%CI 68.9%-94.6%).The occlusion tool software of injection method showed a 89.4%(95%CI 80.4%-94.7%)sensitivity and 80%(95%CI 69.6%-87.6%)specificity in assessing a complete PV occlusion,the positive predictive value was 81.7%(95%CI 72.1%-88.7%)and the negative predictive value was 88.3%(95%CI 78.5%-94.2%).Conclusion The three-dimensional mapping system(KODEX-EPD)occlusion tool software showed good sensitivity and specificity in evaluating PV occlusion during cryoablation.Compared with the baseline method,the injection method and pulmonary venography had higher consistency in evaluating PV occlusion.

关 键 词：心房颤动 三维标测系统 肺静脉封堵 肺静脉造影 基线法 注射法 

分 类 号：R541.75[医药卫生—心血管疾病]