肺静脉节段性隔离与环肺静脉隔离导管消融治疗心房颤动的初步比较

Efficacy and safety of segmental pulmonary vein isolation and circumferential pulmonary vein isolation in patients with atrial fibrillation:a comparative study

目的比较肺静脉节段性隔离(SPVI)与EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融(CPVA)治疗心房颤动的有效性与安全性。方法入选共85例房颤患者,单纯肺静脉环状电极指导下行肺静脉节段性隔离40例(阵发性30例,持续性10例);EnSite Nav X三维电生理系统指导下环肺静脉隔离45例(阵发性31例,持续性14例),随访均超过半年。结果SPVI组成功率为65%,CPVA组成功率为84.4%,P=0.038。主要并发症发生率SPVI组为17.5%,CPVA组为6.7%,P=0.0845;肺静脉狭窄率在CPVA组为0%,在SPVI组为12.5%,P=0.0312。总手术操作时间在SPVI组为(200.4±37.0)min,在CPVA组为(226.5±26.1)min,P=0.002。X线曝光时间在SPVI组为(54.7±9.7)min,在CPVA组为(27.1±3.1)min,P<0.0001。结论EnSite Nav X三维电生理系统指导下环肺静脉隔离导管消融治疗房颤较单纯肺静脉环状电极指导下的节段性肺静脉隔离更为有效且X线曝光时间更短,但手术操作时间较长;主要并发症发生率在两组间无明显差异,但环肺静脉隔离组的肺静脉狭窄率较节段性隔离组低。

Objective To compare the efficacy and safety of segmental pulmonary vein isolation （SPVI） and circumferential pulmonary vein isolation （CPVI） guided by EnSite NavX system in patients with atrial fibrillation （AF）. Methods Eighty-five patients with paroxysmal AF and persistent AF were enrolled in this study. Forty patients （30 with paroxysmal AF and 10 with persistent AF） underwent SPVI procedure, and 45 （31 with paroxysmal AF and 14 with persistent AF） underwent CPVA guided by EnSite NavX three-dimensional electrophysiological mapping system. All the patients were followed up for over six months. Results The success rate was 65% in the SPVI group and 84.4% in the CPVI group （P=0.0332）, with incidence of major complications of 17.5% and 6.7%, respectively （P=0.0845）. In the SPVI group, 12.5% patients had pulmonary vein stenosis after the operation, which occurred in none of the patients in the CPVI group （P=0.0312）. The total procedure time was 200.4±37.0 rain in the SPVI group, significantly shorter than that in the CPVI group （226.5±26.1 min, P=0.002）. The fluoroscopy time in the SPVI group was obviously longer than that in the CPVI group （54.7±9.7 vs 27.1±3.1 min, P〈0.001）. Conclusions CPVI guided by EnSite NavX system is more effective than SPVI for treatment of atrial fibrillation with significantly shortened fluoroscopy time but prolonged procedure time. The two procedures results in comparable incidences of major complications, but CPVI is associated with reduced rate of pulmonary vein stenosis in comparison with SPVI.