高功率短时程在持续性心房颤动改良BOXI术式中的有效性和安全性  

Efficacy and safety of high-power short-duration on the modified box isolation for persistent atrial fibrillation

作　　者：朱春瑜 林春艺[1] 翁兰 杨洵杰 董帝辉 Zhu Chunyu;Lin Chunyi;Weng Lan;Yang Xunjie;Dong Dihui(Second Department of Cardiovascular Medicine,Zhangzhou Municipal Hospital of Fujian Province,Zhangzhou 363100,China)

机构地区：[1]福建省漳州市医院心血管内二科,福建漳州363100

出　　处：《临床荟萃》2024年第10期915-920,共6页Clinical Focus

摘　　要：目的评估在持续性心房颤动(房颤)中应用高功率短时程(high-power short-duration,HPSD)的改良的左心房后壁盒式隔离(box isolation,BOXI)术式的有效性和安全性。方法纳入2020年6月至2022年11月就诊于福建省漳州市医院心血管内二科的持续性房颤患者122例,随机分为HPSD组(n=61)和常规组(n=61)。HPSD组和常规组分别以HPSD和低功率长时程消融完成双侧肺静脉隔离(pulmonary venous isolation,PVI)和改良的BOXI消融。HPSD组使用冷盐水灌注压力感应导管,功率设定为45 W,以消融指数作为指导。常规组以35 W进行消融25~30 s,消融指数、压力指数和HPSD组的设置一致。比较两组基线资料、完成PVI和改良的BOXI的时间、手术总时间、围手术期并发症、单次术后12个月无房性心律失常率等指标。结果HPSD组完成PVI和改良的BOXI的时间和手术总时间均短于常规组(P<0.05)。常规组术后发生心包压塞1例。两组均未出现食管损伤、中风或短暂性脑缺血发作和肺静脉狭窄或死亡。HPSD组和常规组单次手术后12个月的无房性心律失常率分别为70.5%和63.9%,差异无统计学意义(P=0.440)。术后复发第二次手术中,两组肺静脉和改良的BOX电位恢复率差异无统计学意义(P>0.05)。结论持续性房颤改良的BOXI术式采用HPSD是有效、可行且安全的,能缩短总消融时间和手术总时间,且不降低临床疗效。Objective To evaluate the efficacy and safety of high-power short-duration(HPSD)on the modified box isolation(BOXI)for persistent atrial fibrillation(AF).Methods A total of 122 patients with persistent AF who were admitted to the Second Department of Cardiovascular Medicine,Zhangzhou Municipal Hospital of Fujian Province from June 2020 to November 2022 were randomly divided into HPSD group(n=61)and routine group(n=61).Bilateral pulmonary venous isolation(PVI)by the modified BOXI ablation in the HPSD group,and that by low-power long-term ablation in the routine group were performed.A cold saline perfusion pressure sensing catheter with a power setting of 45 W,guided by the ablation index was given in the HPSD group.Ablation at 35 W for 25-30 seconds was performed in the routine group,and the ablation index and pressure index were consistent with those of the HPSD group.Baseline data,time to complete PVI and modified BOXI,total operation time,perioperative complications,and non-atrial arrhythmia rate at 12 months after a single operation were compared between the two groups.Results The time to complete bilateral pulmonary vein isolation and modified BOXI and the total operation time in the HPSD group were significantly shorter than those of the routine group(P<0.05).There was 1 case of postoperative pericardial tamponade in the routine group.No esophageal injury,stroke or transient ischemic attack and pulmonary vein stenosis or death occurred in both groups.The non-atrial arrhythmia rate was 70.5%in the HPSD group and 63.9%in the routine group at 12 months after a single surgery,showing no significant difference(P=0.440).There was no significant difference in the recovery rate of pulmonary vein and modified BOX potential between the two groups during the second operation(P>0.05).Conclusion The use of HPSD in the modified BOXI procedure for persistent AF is effective,feasible,and safe,which significantly reduces total ablation time and procedure time without compromising clinical efficacy.

关 键 词：心房颤动 BOXI 导管消融 高功率 

分 类 号：R541.75[医药卫生—心血管疾病]