不同肺静脉电隔离策略治疗阵发性心房颤动的对比研究

Comparison of different pulmonary vein isolation strategies for patients with paroxysmal atrial fibrillation

目的对现阶段阵发性心房颤动(房颤)肺静脉电隔离治疗最常采用的两种导管消融策略进行比较.方法回顾性分析本院连续完成的第51～100例肺静脉节段性消融术(SPVA组)和第51～100例肺静脉环形消融术(CPVA组)的相关资料,比较两组的操作相关指标、安全性及临床效果.所有患者均为发作频繁、症状严重的阵发性房颤.结果两组的基线资料和平均操作时间差异无统计学意义,但SPVA组的平均X线透视时间较长(P<0.01),平均放电时间较短(P<0.01).术后3个月内CPVA组和SPVA组症状性房性快速心律失常(ATa)的复发率分别为30%和48%(P=0.10).术后随访6个月时,CPVA组有41例(82%)患者在未服用抗心律失常药物的情况下已经至少连续3个月未再发作症状性ATa,而SPVA组仅有30例(60%)达此标准(P<0.05).两组术中各出现1例无症状性右上肺静脉狭窄,无其他重要并发症.结论肺静脉电隔离治疗阵发性房颤的CPVA策略在临床效果方面显著优于SPVA策略,且二者的安全性相当.

Objective To compare two catheter ablation strategies for pulmonary vein （PV） isolation in patients with paroxysmal atrial fibrillation （ PAF）. Methods Fifty consecutive patients who underwent PV isolation by circumferential PV ablation （ CPVA group） were compared with 50 consecutive patients who underwent PV isolation by segmental PV ablation （SPVA group）. The enrolled subjects in this retrospective study were patients with frequent attacks （more than 3 times per month） and symptomatic PAF. Procedure-related parameters, safety and clinical outcome within 6 months after procedures for the 2 strategies were analyzed. Results The characteristics and mean procedure time were comparable between the 2 groups. The mean fluoroscopy time and mean ablation time were 57 min ± 11 min and 42 min ± 9 min in the SPVA group and 31 min ± 8 min and 61 min ±13 min in the CPVA group （both P 〈 0. 01 ）, respectively. After the first procedure, symptomatic atrial tachyarrhythmias （ATa） recurred in 24 （48%） of 50 patients who underwent SPVA and 15 （30%） of 50 patients who underwent CPVA within 3 months （P = 0. 10）. During 6 months of follow-up, 82% of patients with CPVA and 60% of patients with SPVA were free of symptomatic ATa without any antiarrhythmic drugs for at least 3 months （P 〈 0. 05 ）. One patient per each group developed asymptomatic right superior PV stenosis. Conclusion In patients with PAF, CPVA compares favorably with SPVA, but either of them yields a similar clinical safety.