经胸超声心动图结合三维标测系统引导零射线心房颤动射频导管消融术的探索研究  

Feasibility Exploration of Zero-ray Radiofrequency Catheter Ablation of Atrial Fibrillation Guided by Transthoracic Echocardiography Combined With Three-dimensional Mapping System

作　　者：冯天捷[1] 赵广智[1] 董靖 王城 张凤文[1] 王首正[1] 刘俊 牛国栋[3] 唐闽 段福建[4] 潘湘斌[1] FENG Tianjie;ZHAO Guangzhi;DONG Jing;WANG Cheng;ZHANG Fengwen;WANG Shouzheng;LIU Jun;NIU Guodong;TANG Min;DUAN Fujian;PAN Xiangbin(Structural Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Arrhythmia Center,Fuwai Shenzhen Hospital,Chinese Academy of Medical Sciences,Shenzhen 518057,China;Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Ultrasound Imaging Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院结构性心脏病中心,北京100037 [2]中国医学科学院阜外医院,深圳医院心律失常中心,深圳518057 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心律失常中心,北京100037 [4]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院超声影像中心,北京100037

出　　处：《中国循环杂志》2025年第4期374-379,共6页Chinese Circulation Journal

基　　金：国家重点研发计划(2022YFC2503400);中国医学科学院医学与健康科技创新工程(2021-I2M-1-065);中央高水平医院临床科研业务费(2022-GSP-GG-18);中国医学科学院阜外医院国家心血管疾病临床医学研究中心自主课题(NCRC2020009);北京研究型病房卓越临床研究计划项目(BRWEP2024W014030105)。

摘　　要：目的:探索经胸超声心动图结合三维标测系统引导零射线心房颤动(房颤)射频导管消融术的可行性。方法:本研究为单中心、前瞻性、观察性研究,共纳入2024年6月1日至2024年9月30日期间于中国医学科学院阜外医院接受射频导管消融术的12例阵发性房颤患者。所有患者均在经胸超声心动图引导下完成经皮穿刺、房间隔穿刺,然后在超声心动图结合三维标测系统引导下完成左心房建模和放电消融等手术步骤,以消融手术完成后术中验证肺静脉电位消失作为消融终点和成功标志。观察患者的手术情况及1个月和3个月随访结果。结果:12例阵发性房颤患者中,男性9例,女性3例,平均年龄(56.8±11.2)岁,阵发性房颤病史(4.2±2.3)年,左心房内径(36.5±2.5)mm,左心室舒张末期内径(47.8±4.1)mm,左心室射血分数55%~65%。患者的平均总手术时间为(102.25±14.51)min,超声心动图操作时间为(29.58±6.23)min,导管操作时间为(33.08±4.10)min。所有患者均完成环肺静脉隔离,术中未发生并发症。患者的住院时间为2~6 d。术后1个月随访时,所有患者的动态心电图均显示窦性心律,2例偶发房性早搏,无房颤复发;术后3个月随访时,2例患者仍偶发房性早搏,所有患者的心电图均未记录到房颤复发。结论:经胸超声心动图结合三维标测系统全程引导零射线射频导管消融术治疗阵发性房颤可行。Objectives:To explore the feasibility of zero-ray radiofrequency catheter ablation for paroxymal atrial fibrillation under the guidance of transthoracic echocardiography combined with three-dimensional mapping system.Methods:This is a single-center prospective observational study.A total of 12 patients with paroxysmal atrial fibrillation who underwent radiofrequency catheter ablation in Fuwai Hospital,Chinese Academy of Medical Sciences from June 1,2024 to September 30,2024 were included.All patients underwent successful percutaneous puncture,atrial septal puncture under the guidance of transthoracic echocardiography,and all patients underwent left atrial modeling and discharge ablation under the guidance of transthoracic echocardiography combined with three-dimensional mapping system.The disappearance of pulmonary vein potential was confirmed after the ablation operation and as the ablation endpoint and successful ablation marker.The operation results and 1-month and 3-month follow-up results of the patients were observed.Results:There were 12 patients with paroxysmal atrial fibrillation,9 males and 3 females,aged(56.8±11.2)years,with a history of paroxysmal atrial fibrillation(4.2±2.3)years.The mean left atrial diameter was(36.5±2.5)mm,the left ventricular end-diastolic diameter was(47.8±4.1)mm,and the left ventricular ejection fraction was 55%-65%.The mean overall operation time was(102.25±14.51)min,the ultrasound operation time was(29.58±6.23)min,and the catheter operation time was(33.08±4.10)min.All patients completed circumferential pulmonary vein isolation without intraoperative complications.The hospitalization time was 2-6 days.At the 1-month follow-up after ablation,all patients showed sinus rhythm on 24-hour ambulatory electrocardiogram,and 2 patients had occasional atrial premature contractions without recurrence of atrial fibrillation.At the 3-month follow-up,two patients had occasional premature atrial contractions,and no recurrence of atrial fibrillation was recorded on the electrocardiogram

关 键 词：射频导管消融术 心房颤动 经胸超声心动图 零射线 

分 类 号：R54[医药卫生—心血管疾病]