心房颤动冷冻球囊消融术中膈神经损伤预防策略研究进展  

Strategies for preventing phrenic nerve injury during cryoballoon ablation of atrial fibrillation:research progress

作　　者：彭荣兵 于曼丽[1] 郭志福[1] PENG Rongbing;YU Manli;GUO Zhifu(Department of Cardiovasology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院心血管内科,上海200433

出　　处：《海军军医大学学报》2025年第2期239-243,共5页Academic Journal of Naval Medical University

基　　金：海军军医大学(第二军医大学)第一附属医院基础医学研究专项(2023PY43);海军军医大学(第二军医大学)第一附属医院教学成果立项培育项目(CGPY2021B09).

摘　　要：心房颤动是临床常见的心律失常之一,具有高发病率和高致残率,给社会和经济带来了沉重的负担。多数心房颤动起源于肺静脉,因此肺静脉隔离是导管消融治疗心房颤动的主要术式。冷冻球囊消融具有损伤可逆、手术时间短、患者手术体验佳等优点,目前已广泛应用于临床,成为心房颤动的一线治疗方案。与射频消融相比,冷冻球囊消融发生膈神经损伤的风险相对更高,尤其是在对右侧肺静脉冷冻消融期间。本文旨在讨论冷冻球囊消融治疗心房颤动过程中预防膈神经损伤的策略,例如冷冻消融的温度监控、球囊操作的策略(即球囊放气、近端封堵、膈神经起搏等),以总结经验,从而有效预防并发症的发生。Atrial fibrillation is one of the most common arrhythmias;its high incidence rate and high disability rate lead to heavy social and economic burdens.Most atrial fibrillation originates from pulmonary veins,so pulmonary vein isolation is the mainstay of catheter ablation for the treatment of atrial fibrillation.Cryoballoon ablation has the advantages of reversible injury,short operation time,and better surgical experience for patients.At present,it has been widely used in clinical practice and has become the first-line treatment scheme for atrial fibrillation.However,compared with radiofrequency ablation,cryoballoon ablation carries a relatively higher risk of causing phrenic nerve injury,particularly during the process of cryoablation targeting the right pulmonary vein.Therefore,this article aims to discuss the strategies for preventing phrenic nerve injury during cryoballoon ablation for atrial fibrillation,such as the temperature monitoring during cryoablation and the strategies of balloon operation(i.e.balloon deflation,proximal occlusion,phrenic nerve pacing),so as to summarize the experience and effectively prevent complications.

关 键 词：心房颤动 冷冻消融 膈神经损伤 预防 

分 类 号：R541.75[医药卫生—心血管疾病]