高级检索
    胡晓芹, 李承宗, 李菲, 葛力萁, 韦慧, 张权, 陈文苏, 张超群, 王志荣. 消融指数指导下单导管高功率射频消融在肺静脉隔离中的短期疗效及安全性[J]. 徐州医科大学学报, 2022, 42(9): 666-671. DOI: 10.3969/j.issn.2096-3882.2022.09.009
    引用本文: 胡晓芹, 李承宗, 李菲, 葛力萁, 韦慧, 张权, 陈文苏, 张超群, 王志荣. 消融指数指导下单导管高功率射频消融在肺静脉隔离中的短期疗效及安全性[J]. 徐州医科大学学报, 2022, 42(9): 666-671. DOI: 10.3969/j.issn.2096-3882.2022.09.009
    shu
    (XYFM2021007)[J]. Journal of Xuzhou Medical University, 2022, 42(9): 666-671. DOI: 10.3969/j.issn.2096-3882.2022.09.009
    Citation: (XYFM2021007)[J]. Journal of Xuzhou Medical University, 2022, 42(9): 666-671. DOI: 10.3969/j.issn.2096-3882.2022.09.009
    shu

    消融指数指导下单导管高功率射频消融在肺静脉隔离中的短期疗效及安全性

    (XYFM2021007)

      摘要
    • 摘要: 目的：随着导管消融技术的发展，在心房颤动（房颤）射频消融中使用单消融导管行肺静脉隔离（pulmonary vein isolation, PVI）成为临床上可行的手术方式。本研究探讨消融指数（ablation index, AI）指导下单导管高功率射频消融在肺静脉隔离中的安全性和有效性。方法：回顾性纳入77例行房颤导管射频消融患者，分为单导管高功率消融（High Power，HP）组37例和常规功率消融（Conventional Power，CP）组40例，两组均以消融指数为参考。HP组应用单消融导管（SmartTouch Surrounding Flow，STSF）进行标测和消融，功率45-50W；CP组应用消融导管（SmartTouch，ST)，在环状标测导管指导下进行消融，功率30-35W。所有患者AI目标值为前壁450-500，顶部400-450，后壁和底部350-400。消融终点为双侧肺静脉隔离即心房、肺静脉双向传导阻滞。比较两组患者一般基线资料、消融相关参数（每点消融时间、每点阻抗下降率、肺静脉隔离时间、总手术时间、左/右肺静脉单圈隔离率、盐水灌注量）、并发症以及随访6个月成功率的差异。结果：常规功率消融组与单导管高功率消融组的基线资料差异无统计学意义；与CP组相比，HP组肺静脉隔离时间缩短(25.0±3.8min vs 40.0±4.9min, P<0.01)，总手术时间缩短(153.8±44.1min vs 176.4±36.1min, P<0.05)，每点消融电阻抗下降率更低(13.0±1.7% vs 14.5±1.5%, P<0.01)，盐水灌注量减少(756.9±196.6ml vs 986.7±184.3ml, P<0.01);对于单圈隔离率, 高功率组的左/右肺静脉更高,但差异无统计学意义(左:70% vs 86.5%, P>0.05; 右:80% vs 91.9%, P>0.05)。在围术期及随访中，仅CP组术中发生1例股静脉穿刺处血肿。所有患者完成6个月随访，维持窦律方面，HP组与CP组的成功率无统计学差异(85.4% vs 75%, P>0.05)；在持续性房颤中，HP组的成功率高于CP组，但无统计学差异(83.3% vs 64.7%, P>0.05)。仅CP组有1例股静脉穿刺处血肿。结论：与常规功率环状标测导管指导下的肺静脉隔离相比，AI指导下的单消融导管高功率消融可以提高手术效率，缩短肺静脉隔离时间及总手术时间，是安全有效的。关键词 心房颤动；射频消融；高功率；消融指数方法：回顾性纳入77例行房颤导管射频消融患者，分为单导管高功率消融（HP）组37例和常规功率消融（CP）组40例，两组均以消融指数为参考。HP组应用STSF单消融导管进行标测消融，功率45-50W；CP组应用ST消融导管、在环状标测导管指导下进行消融，功率30-35W。所有患者AI目标值为前壁450-500，顶部400-450，后壁和底部350-400。消融终点为双侧肺静脉隔离即心房、肺静脉双向传导阻滞。比较两组患者一般基线资料、消融效果（每点消融时间、每点阻抗下降率、肺静脉隔离时间、总手术时间、肺静脉隔离成功率、盐水灌注量）、并发症以及随访6个月复发率的差异。结果：常规功率消融组与单导管高功率消融组的基线资料无统计学差异；与CP组相比，HP组肺静脉隔离时间缩短(25.0±3.8min vs 40.0±4.9min, P<0.01)，总手术时间缩短(153.8±44.1min vs 176.4±36.1min, P<0.05)，每点消融电阻抗下降率更低(13.0±1.7% vs 14.5±1.5%, P<0.01 )，盐水灌注量减少(756.9±196.6ml vs 986.7±184.3ml, P<0.01)，单圈隔离率更高(87.5% vs 75%, P<0.01)。在围术期及随访中，仅CP组术中发生1例股静脉穿刺处血肿。所有患者完成6个月随访，HP组与CP组的成功率无统计学差异(85.4% vs 75%, P=0.2)；在持续性房颤患者中，HP组的成功率高于CP组，但无统计学差异(83.3% vs 64.7 %, P=0.21)。结论：与常规功率环状标测导管指导下的肺静脉隔离相比，AI指导下的单消融导管高功率消融可以提高手术效率，缩短肺静脉隔离时间及总手术时间，是安全有效的。

       

      Abstract: ob＜x＞jective With the development of ablation catheter technology, pulmonary vein isolation(PVI) with the single ablation catheter has become a clinically feasible approach in patients with atrial fibrillation (AF). This study investigated the safety and efficacy of high-power ablation for atrial fibrillation guided by ablation index (AI) using a single ablation catheter. Methods We included 77 consecutive patients including high power (HP) group (n = 37) and conventional power (CP) group (n = 40) who underwent PVI guided by AI in the affiliated hospital of Xuzhou medical university from January to May 2021. The patients in CP group were treated with standard protocol (SmartTouch catheter and circular mapping catheter, 25-35 Walt) and HP group with high-power protocol (SmartTouch Surrounding Flow catheter, 45-50 Walt). AI value targets of 450-500 anterior, 400-450 roof and 350-400 posterior and inferior were used. The end point of ablation was bilateral pulmonary vein isolation. PVI was documented with entrance and exit block. The patient characteristics, procedure characteristics including ablation time per lesion, the rate of impendence drop, PVI time, procedure duration, the rate of first-pass PVI and irrigated saline volume, and perioperative complications, recurrence rate at 6-months follow-up were analyzed between the two groups. Results There were no significant differences in the patients’ ba＜x＞seline data between conventional power ablation group and single-catheter high-power ablation group (P>0.05). Compared with CP group, HP group had shorter PVI time (25.0±3.8min vs 40.0±4.9min, P<0.01), shorter procedure time(153.8±44.1min vs 176.4±36.1min, P<0.05), lower impendence drop rate (13.0±1.7% vs 14.5±1.5%, P<0.01) and lower irrigated saline volume (756.9±196.6ml vs 986.7±184.3ml, P<0.01), whereas, the rate of left veins and right veins first-pass PVI rate was no significant differences in the HP group than that in the CP group (70% vs 86.5%, P>0.05; 80% vs 91.9%, P>0.05)). In these patients’, only one case with groin hematoma was observed in the CP group. Six-months freedom of AF /AT /AFL was similar in the Hp group and the CP group (86.5% vs 75.0%, P=0.20>0.05; and persistent AF: 83.3% vs 64.7%, P=0.26>0.05). There were no major complication except one case of femoral vein hematoma in the CP group.Conclusion AI-guided high power atrial fibrillation ablation with single STSF ablation catheter was safe and efficient strategy, and shorten PVI time and procedure time.

       

      • HTML全文
      • 参考文献(0)
      • 相关文章
      • 施引文献
    • 资源附件(0)

    /

    返回文章
    返回