消融指数指导下高功率消融在心房颤动导管消融中的应用  

Clinical benefits of intensified atorvastatin intervention perioperative coronary intervention therapy

作　　者：丁文龙[1] 方存明 马小林 黄政 章敬水 李镇 唐龙 吴祖飞 DING Wenlong;FANG Cunming;MA Xiaolin;HUANG Zheng;ZHANG JingShui;LI Zhen;TANG Long;WU Zufei(Department of Cardiology,The Affiliated Xuancheng Hospital of Wannan Medical College(Xuancheng People's Hospital),Xuancheng 242000,China)

机构地区：[1]皖南医学院附属宣城医院(宣城市人民医院)心内科,242000

出　　处：《心肺血管病杂志》2024年第9期934-938,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：2023年宣城市卫生健康科研项目(XCWJ2023032);2022年院级科研项目(KY202212)。

摘　　要：目的:探讨消融指数(ablation index,AI)指导下高功率消融在心房颤动导管消融中的应用价值。方法:入选2020年4月至2023年7月,在皖南医学院附属宣城医院住院的阵发性及持续性心房颤动患者158例。根据入组时间先后顺序分为两组,常规组(71例)消融功率设为30~35W,高功率组(87例)设为40W,高功率组以AI值为参考进行导管射频消融,以达到肺静脉前庭电隔离为消融目标,必要时加辅助线消融。对比两组的手术时间、单点消融时间、肺静脉隔离(pulmonary vein isolation,PVI)时间、X线曝光时间、肺静脉单圈隔离率、肺静脉即时隔离率、并发症发生率、心房颤动复发情况。结果:与常规组相比,高功率组的手术时间、单点消融时间、PVI时间和X线曝光时间均明显更短(P<0.05),液体灌注量明显更少(P<0.05)。肺静脉即时隔离率均为100.00%,但高功率组的PVI单圈隔离率显著高于常规组(P<0.05)。高功率组的消融并发症总发生率与常规组无统计学差异。高功率组心房颤动复发率为10.3%,显著低于常规组的23.9%(P<0.05)。结论:以AI值为参考的高功率射频消融治疗心房颤动的消融效率高,同时能提高肺静脉单圈隔离率,降低心房颤动复发率,疗效好,并发症少,该消融策略安全可行。Objective:To explore the application value of high-power ablation guided by ablation index(AI) in catheter ablation of atrial fibrillation.Methods:A total of 158 patients with paroxysmal and persistent atrial fibrillation admitted to the Affiliated Xuancheng Hospital of Wannan Medical College from April 2020 to July 2023 were selected.They were divided into two groups according to the order of enrollment time.The ablation power was set at 30-35W in the conventional group(71 cases) and 40W in the high-power group(87 cases),both aimed at achieving pulmonary vein vestibular electrical isolation.Compare the surgical time,single point ablation time,PVI time,X-ray exposure time,pulmonary vein single loop isolation rate,immediate success rate of surgery,incidence of complications,and recurrence rate of atrial fibrillation between the two groups.Results:Compared with the conventional group,the high-power group had significantly shorter surgical time,single point ablation time,PVI time,and X-ray exposure time(P<0.05),and significantly less fluid infusion volume(P<0.05).The immediate isolation rates of pulmonary veins were all 100.0%,but the PVI single circle isolation rate in the high-power group was significantly higher than that in the conventional group(P<0.05).There was no statistically significant difference in the total incidence of ablation complications between the high-power group and the conventional group.The recurrence rate of atrial fibrillation in the highpower group was 10.3%,significantly lower than the 23.9% in the conventional group(P<0.05).Conclusion:High power radiofrequency ablation based on AI values has a high ablation efficiency in the treatment of atrial fibrillation,while also improving the pulmonary vein single ring isolation rate and reducing the recurrence rate of atrial fibrillation.The ablation strategy has good efficacy and fewer complications,making it safe and feasible.

关 键 词：心房颤动 导管消融术 消融指数 高功率 肺静脉隔离 

分 类 号：R54[医药卫生—心血管疾病]