高功率短时程脉冲式消融电隔离上腔静脉的有效性和安全性  

Efficacy and Safety of High-Power Short-Range Pulse AblationElectrical Isolation for Superior Vena Cava

作　　者：白雪洋[1] 白中乐[1] 洪晋 王琎 陈晓伟[1] 郭树领 赵平 BAI Xueyang;BAI Zhongle;HONG Jin;WANG Jin;CHEN Xiaowei;GUO Shuling;ZHAO Ping(Department of Cardiovascular Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Cardiovascular Medicine,Xuchang Central Hospital,Xuchang 461000,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450052 [2]许昌市中心医院心血管内科,河南许昌461000

出　　处：《河南医学研究》2024年第24期4430-4432,共3页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190099)。

摘　　要：目的 探讨高功率短时程脉冲式消融方法电隔离上腔静脉(SVC)的有效性和安全性。方法 回顾性分析2023年1月至2023年10月在郑州大学第一附属医院心血管内科一病区和许昌市中心医院心血管内科一病区接受导管射频消融术且接受SVC电隔离术的108例心房颤动患者。SVC消融策略为首选节段性消融,先进行SVC间隔侧消融,之后消融前壁和后壁,最后消融游离壁侧。消融间隔侧时为连续放电策略,消融前壁、后壁和游离壁时采用高功率短时程脉冲式放电。有效性指标为完成SVC电隔离,安全性指标为心脏压塞、窦房结损伤和膈神经损伤。结果 有107例(99.1%)心房颤动患者完成SVC电隔离,在成功完成SVC电隔离的患者中,所有患者均需要进行间隔侧消融,89例(83.2%)患者进行了前壁侧消融,63例(58.9%)患者进行了后壁侧消融,101例(94.4%)患者进行了游离壁侧消融。采用高功率短时程脉冲式消融时每点放电4(3,5)次达到消融终点。从SVC建模至完成SVC电隔离的时间是7(6,8)min。完成SVC电隔离后观察15 min电位均未恢复。所有患者均未出现心脏压塞、窦房结损伤和膈神经损伤。结论 采用高功率短时程脉冲式放电消融的方法可以高效和安全地完成SVC的电隔离。Objective To investigate the efficacy and safety of high-power short-range pulse ablation electrical isolation for superior vena cava(SVC).Methods A retrospective analysis was conducted on 108 patients with atrial fibrillation who underwent catheter radiofrequency ablation and SVC electrical isolation surgery in the Cardiovascular Department of the First Affiliated Hospital of Zhengzhou University and the Cardiovascular Department of Xuchang Central Hospital from January 2023 to October 2023.The preferred ablation strategy for the SVC was segmental ablation,starting with ablation of the septal side of the SVC,followed by ablation of the anterior and posterior walls,and finally ablation of the free wall side.The continuous discharge strategy was adopted for the ablation interval side,and high-power short-term pulse discharge was used for the ablation of the front wall,back wall and free wall.The effectiveness indicators were completion of SVC electrical isolation,while the safety indicators were cardiac tamponade,sinus node injury,and phrenic nerve injury.Results There were 107 cases(99.1%)of atrial fibrillation patients completed SVC electrical isolation.Among the patients who successfully completed SVC electrical isolation,all patients required septal ablation,89 patients(83.2%)underwent anterior wall ablation,63 patients(58.9%)underwent posterior wall ablation,and 101 patients(94.4%)underwent free wall ablation.When using high-power short-range pulse ablation,4(3,5)discharges per point were discharged to reach the ablation endpoint.The time from modeling the SVC to completing SVC electrical isolation was 7(6,8)minutes.After completing the SVC electrical isolation,the potential did not recover after 15 minutes of observation.All patients did not experience cardiac tamponade,sinus node injury or phrenic nerve injury.Conclusion The method of high-power short-range pulse ablation can efficiently and safely complete the electrical isolation of the SVC.

关 键 词：心房颤动 射频消融 上腔静脉电隔离 高功率短时程 脉冲式消融 

分 类 号：R541.7[医药卫生—心血管疾病]