冷冻消融术中肺静脉电隔离时间记录率影响因素分析

Analysis the influence factors of observation rate of pulmonary vein time to isolation during cryoablation

目的探讨心房颤动冷冻消融术中肺静脉电隔离时间(TTI)记录率的影响因素。方法回顾性分析自2018年1月至2022年4月于北部战区总医院住院并于第二手术间接受第二代冷冻球囊消融治疗的479例心房颤动患者的临床资料。分析逐年TTI记录率的变化特征,并分析不同术者、不同肺静脉分支及不同类型标测电极的TTI记录率。结果2018年TTI记录率为33.3%(132/396),2019年为50.0%(128/256),2020年为55.6%(209/376),2021年为50.4%(204/405),2022年为62.2%(317/510)。左上肺静脉总TTI记录率为65.3%(313/479),左下肺静脉总TTI记录率为50.2%(239/476),右上肺静脉总TTI记录率为50.7%(242/477),右下肺静脉的总TTI记录率为38.2%(182/477)。总结5位术者5年平均TTI记录率分别为46.3%(291/628)、35.7%(117/328)、57.1%(113/198)、64.1%(236/368)、55.3%(233/421)。一代Achieve电极总TTI记录率为47.3%(673/1433),二代Achieve电极总TTI记录率为62.2%(317/510),差异有统计学意义(χ^(2)=3.90,P=0.04)。结论2018—2022年本中心肺静脉TTI记录率呈上升趋势,不同分支肺静脉TTI记录率不同,左上肺静脉记录率最高,右下肺静脉记录率最低,且不同术者操作技巧对TTI记录率也具有一定的影响。应用二代Achieve电极可明显提高TTI记录率并减少手术时间,优化手术流程。

Objective To analysis the influence factors of observation rate of pulmonary vein time to isolation(TTI)during cryoablation.Methods The clinical data of 479 patients with atrial fibrillation who were hospitalized in the General Hospital of Northern Theater Command from January 2018 to April 2022 and underwent second-generation cryoballoon ablation in second operating room were retrospectively analyzed.The characteristics of TTI observation rate from year to year were analyzed,and the TTI observation rate of different pulmonary vein branches,different types of mapping electrodes and different operators were analyzed.Results The TTI observation rate was 33.3%(132/396)in 2018,50.0%(128/256)in 2019,55.6%(209/376)in 2020,50.4%(204/405)in 2021,and 62.2%(317/510)in 2022.The total TTI observation rate of left superior pulmonary vein was 65.3%(313/479),left inferior pulmonary vein was 50.2%(239/476),right superior pulmonary vein was 50.7%(242/477),and right inferior pulmonary vein was 38.2%(182/477).The TTI observation rates of 5 physicians in 5-year were 46.3%(291/628),35.7%(117/328),57.1%(113/198),64.1%(236/368)and 55.3%(233/421),respectively.The total TTI recording rate of the first generation Achieve electrode was 47.3%(673/1433),and the total TTI recording rate of the second generation Achieve electrode was 62.2%(317/510),the difference was statistically significant(χ^(2)=3.90,P=0.04).Conclusion From 2018 to 2022,the TTI observation rate in our center increased year by year.The TTI observation rate was different in different branches of pulmonary veins.The left superior pulmonary vein had the highest observation rate,while the right inferior pulmonary vein had the lowest observation rate.The application of the second-generation Achieve electrode can significantly improve the TTI observation rate,reduce the operation time,and optimize the operation process.