联合Marshall静脉无水酒精及二尖瓣峡部线性消融对持续性房颤“BOX”消融策略的作用  

Effects of Vein of Marshall Ethanol Infusion and Mitral Isthmus Linear Ablation on BOX Ablation Strategy for Persistent Atrial Fibrillation

作　　者：龚倩 赖柱宏 何渠帅 李郁 杜薇 宋攀 罗彩东 黎东 Gong Qian;Lai Zhuhong;He Qushuai(Department of Cardiology,Mianyang Central Hospital,University of Electronic Science and Technology of China,Mianyang,Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院心血管内科,四川绵阳621000

出　　处：《四川医学》2025年第1期18-23,共6页Sichuan Medical Journal

基　　金：四川省卫生健康委员会医学科技项目(普及应用项目)(编号:21PJ179)。

摘　　要：目的评估联合肺静脉电隔离(PVI)及左房后壁电隔离的“BOX”消融策略基础上,进一步联合Marshall静脉(VOM)无水酒精消融及二尖瓣峡部线性消融能否提高持续性房颤射频消融手术的成功率。方法连续纳入2021年6月到2022年3月在我院行射频消融的持续性房颤患者56例作为研究组,手术策略采用VOM无水酒精消融+PVI+左房后壁电隔离+二尖瓣峡部线性消融。回顾性将2020年5月至2021年5月期间在本院采用“BOX”消融策略并定期随访的持续性房颤患者,用左房大小(前后径)和年龄与研究组患者做1∶1倾向得分匹配后纳入对照组。结果所有患者术中均实现PVI和左房后壁电隔离,研究组患者中有51例成功完成VOM无水酒精及二尖瓣峡部线性消融,二尖瓣峡部线在术中实现100%双向阻滞。所有患者均无严重手术相关并发症。经过平均(16.8±5.5)月随访,研究组中总共有43例患者(76.8%)在单次消融后无房颤/房速复发,对照组有35例(62.5%)无房颤/房速复发(P<0.05)。Kaplan-Meier生存分析发现,研究组患者的手术成功率高于对照组(P<0.05)。结论联合应用VOM无水酒精消融及二尖瓣峡部线性消融,可显著提高持续性房颤“BOX”消融策略的手术成功率,且安全性高。Objective To evaluate whether vein of Marshall(VOM)ethanol infusion and linear mitral isthmus ablation improve the success rate of catheter ablation for persistent atrial fibrillation after BOX ablation strategy of pulmonary vein isolation(PVI)and left posterior wall electrical isolation or not.Methods 56 patients with persistent atrial fibrillation who underwent catheter ablation from June 2021 to March 2022 were included as study group.Surgical strategy was VOM ethanol infusion+PVI+left atrial posterior wall electrical isolation+mitral isthmus linear ablation.56 left atrial size(anteposterior diameter)and age-matched patients with persistent atrial fibrillation who were treated with BOX ablation strategy were served as the historical control group.Results Electrical isolation of pulmonary vein and electrical isolation of left posterior atrial wall were achieved in all patients.In study group,51 patients successfully completed VOM ethanol infusion and ablation of mitral isthmus,and mitral isthmus line achieved 100%bidirectional block during the operation.There were no serious surgery-related complications in all cases.After a mean follow-up of(16.8±5.5)months,a total of 43 patients(76.8%)in study group and 35 patients(62.5%)in control group were free of atrial fibrillation/tachycardia after a single ablation(P<0.05).Kaplan-Meier survival analysis found that surgical success rate was higher in study group than in control group(P<0.05).Conclusion The combination of VOM ethanol infusion and ablation of mitral isthmus could significantly improve the success rate of BOX ablation strategy for persistent atrial fibrillation with high safety.

关 键 词：持续性房颤 Marshall静脉 左房后壁电隔离 二尖瓣峡部 

分 类 号：R541.7[医药卫生—心血管疾病]