脉冲电场消融房室折返性心动过速的有效性与安全性初探  

Preliminary exploration of the effectiveness and safety of pulsed field ablation for atrioventricular reciprocating tachycardia

作　　者：戴嘉挺 储慧民[2] 丰明俊[2] 郁一波[2] 杜先锋 傅国华 俞理璞 蒋永兴 金河 吴涛 陈思[2] 卓韦东 王彬浩 高昉 方任远 贾振宇 孙一钧 卢亦琦 沈才杰[2] Dai Jiating;Chu Huimin;Feng Mingjun;Yu Yibo;Du Xianfeng;Fu Guohua;Yu Lipu;Jiang Yongxing;Jin He;Wu Tao;Chen Si;Zhuo Weidong;Wang Binhao;Gao Fang;Fang Renyuan;Jia Zhenyu;Sun Yijun;Lu Yiqi;Shen Caijie(Health Science Center,Ningbo University,Ningbo 315000,China;Cardiac Arrhythmia Center,The First Affiliated Hospital of Ningbo University,Ningbo 315000,China)

机构地区：[1]宁波大学医学部,宁波315000 [2]宁波大学附属第一医院心律失常诊疗中心,宁波315000

出　　处：《中华心律失常学杂志》2024年第6期482-487,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：宁波市重点研发计划(2023Z188)

摘　　要：目的探究单中心脉冲电场消融(PFA)治疗房室折返性心动过速(AVRT)患者的可行性、有效性与安全性。方法本研究为前瞻性、单臂、观察性、描述性研究。纳入2022年3月至6月在宁波大学附属第一医院心律失常诊疗中心接受PFA治疗的阵发性室上性心动过速患者40例,经过电生理检查,排除了明确诊断为房室结折返性心动过速(AVNRT)的25例患者,最终纳入了15例AVRT患者。在三维电标测系统和X线指导下使用管状PFA导管进行旁路标测和消融,左侧旁路采取房间隔穿刺途径消融,PFA导管头端于靶点发放双极和/或双相脉冲电场,电压为-1000~1000 V,发放持续时间100 ms/次。患者于术后24 h内进行体表心电图及血生化等指标检测,术后1个月进行超声心动图检查和血生化等指标复查,于第1、3、6个月接受12导联体表心电图和24 h动态心电图检查,必要时行经食管调搏检查。所有左侧旁路消融患者,术后2周内行头颅磁共振检查。结果入选的15例AVRT患者全部于术中达到消融终点,旁路位置:正左、右侧游离壁各1例,左后及左前侧游离壁各5例,左、右后间分别1例和2例。消融总数量(5.2±2.0)个,靶点消融数量1.0(1.0,2.0)个,巩固消融数量(3.8±2.1)个;总消融时间(7.4±5.1)s,包括靶点消融时间2.3(1.6,5.3)s,巩固消融时间3.0(1.2,7.0)s。总手术时间(67.1±17.0)min,植入鞘管到出鞘管时间(60.6±15.8)min,PFA导管留置心腔内时间(29.6±7.4)min,房间隔穿刺时间(7.3±3.4)min,X线曝光时间(6.9±2.2)min。术后随访终点无一例复发。除1例术中发生短暂窦性停搏外,随访期间未在任何患者上记录到与PFA相关的严重并发症。结论脉冲电场消融AVRT可行,且具有较好的安全性和有效性。Objective To explore the feasibility,efficacy and safety of pulsed field ablation(PFA)for atrioventricular reciprocating tachycardia(AVRT)in a single center.Methods This study was a prospective,single-arm,observational and descriptive study.From March 2022 to June 2022,40 patients with paroxysmal supraventricular tachycardia were treated with PFA at the Cardiac Arrhythmia Center of The First Affiliated Hospital of Ningbo University.After electrophysiological examination.Twenty-five cases confirmed as atrioventricular nodal reentrant tachycardia(AVNRT)were excluded,resulting in the inclusion of 15 patients with definitive AVRT.A focal PFA catheter was used for accessory pathway mapping and ablation navigated with a 3D mapping system and X-rays.Ablation of the left-sided accessory pathways was performed using a transseptal approach.The focal PFA catheter was positioned at the target to deliver bipolar/biphasic pulsed electric fields with a voltage of±1000 V and a duration of 100 ms per pulse.Patients underwent 12-lead surface electrocardiogram and blood testing within 24 hours postoperatively,transthoracic echocardiography and repeat blood testing at the 1-month follow-up,and 12-lead surface electrocardiogram and Holter monitoring at months 1,3,and 6,with transesophageal pacing when necessary.All patients who underwent ablation of left-sided accessory pathways had cranial magnetic resonance imaging within 2 weeks following the procedure.Results All 15 patients(100%)with AVRT enrolled achieved acute ablation endpoints.The cohort consisted of 1 left lateral and 1 right lateral free wall,5 left posterior and 5 left anterior free wall,and 1 left and 2 right posterior septum.The average total number of ablation sites(AS)was 5.2±2.0,including 1.0(1.0,2.0)at as targets and 3.8±2.1 as consolidation AS.The mean total ablation time was(7.4±5.1)s,including 2.3(1.6,5.3)s for targets and 3.0(1.2,7.0)seconds for consolidation AS.The total procedure time was(67.1±17.0)min,skin-to-skin time was(60.6±15.8)min,PFA catheter dwe

关 键 词：导管消融术 脉冲电场消融 旁路 房室折返性心动过速 

分 类 号：R54[医药卫生—心血管疾病]