犬心外膜与心内膜侧环肺静脉射频消融治疗心房颤动的对比研究

The comparative study of effects on atrium between epicardial and endocardial catheter radiofrequency ablation guided by Carto merge image

目的采用介入方法对犬分别在心外膜和心内膜侧进行环肺静脉射频消融，比较两者心房颤动（房颤）诱发率的异同。方法20条犬随机分为A、B两组，术前行64-CT扫描，术中在Cartomerge影像融合技术的指导下分别行心外膜侧（A组）与心内膜侧（B组）的环肺静脉射频消融，消融后对比观察房颤诱发率、去迷走神经效应、肺静脉电隔离率、心房不应期和心房不应期离散度等指标。结果消融前、后房颤诱发率A组（66／100；18／100，P〈0．05）；B组（60／100；20／100，P〈0．05）。去迷走神经效应（A组8／10；B组5／10，P：0．1749）。左上肺静脉电隔离率（A组1／10；B组4／10，P：0．1517）；右上肺静脉电隔离率（A组2／10；B组5／10，P：0．1749）。消融前、后心房不应期A组[（112±5，37）ms；（120±6．24）ms，P〈0，05]；B组[（108，5±4．74）ms；（119．5±5．99）ms，P〈0．05]。消融前、后心房不应期离散度A组（（28．5±8．12）ms；（8，5±4，74）ms，P〈0．05]；B组（（27±6．32）ms；（9．5±4．38）ms，P〈0，05]。两组犬消融后均无急性冠状动脉损伤。结论采用介入方法在Cartomerge影像指导下心外膜侧和心内膜侧环肺静脉消融均可以降低房颤的诱发率，心外膜侧消融可以安全进行。

Objective To compare the effect of ablation on atrium between epicardial circumferential pulmonary vein ablation（CPVA） and endocardial CPVA to cure atrial fibrillation（AF）. Methods Twenty canines were divided into two groups randomly. All of them underwent 64-slice muhislice computed tomography （64-CT） before catheter ablation. Guided by image fusing of 64-CT with electroanatomic mapping, group A underwent epicardial CPVA and group B underwent endocardial CPVA. We observed inducibility of AF, vagal denervation, isolation of pulmonary vein, atrial effective refractory period （AERP） , AERP dispersion before and after ablation. Results Inducibility of AF before and after ablation（ group A 66/100 vs 18/100, P 〈 0. 05 ;group B 60/100 vs 20/100, P 〈 0. 05 ）, vagal denervation（ group A 8/10 vs group B 5/10, P = 0. 1749 ） ,isolation of left super pulmonary vein（LSPV） （group A 1/10 vs group B 4/10,P=0. 1517） ,isolation of RSPV（group A 2/10 vs group B 5/10,P =0. 1749） ,AERP[ group A（112±5.37）ms vs（120 ±6.24） ms,P 〈0.05;group B（108. 5±4. 74）ms vs（ 119. 5±5.99） ms,P 〈0. 053],AERP dispersion[ group A（28.5±8.12）ms vs（8.5±4.74）ms,P 〈 0. 05 ;group B（27±6. 32）ms vs（9. 5±4. 38）ms,P〈0. 053]. No acute injure happened to coronary artery in two groups. Conclusion Both epicardial CPVA and endocardial CPVA can suppress the inducibility of AF. Epicardial CPVA can be performed guided by Carto merge image safely.