慢性心房颤动导管消融:碎裂电位消融和线性消融的比较

Catheter ablation of chronic atrial fibrillation:a comparison between complex fractionated atrial electrograms ablation and linear ablation

目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)消融或(和)线性(Linear)消融进行心房基质改良的疗效。方法回顾性分析156例慢性心房颤动(简称房颤)消融病例,房颤病程2.5±2.3年,左房内径42.4±4.5 mm。根据消融术式改进分为三组CPVI+CFAEs、CPVI+linear和CPVI+CFAEs+Linear组。比较消融术中房颤终止比例及随访疗效。结果三组消融总时间有显著性差异(160±14 min vs 178±9 min vs 241±8min,P<0.01)。CPVI+CFAEs组终止房颤/转变房性心动过速(简称房速)的比例(52.7%)显著高于CPVI+Line-ar组(18.4%),但低于CPVI+CFAEs+Linear组(73.1%)。术后3.1±1.2个月,三组二次消融比例47.3%、51%、38.5%,P=0.43。术后平均随访9.5±1.8个月,三组无房性快速性心律失常复发例数分别为39例(70.9%)、33例(67.3%)和41例(78.8%),P=0.41(服用抗心律失常药物比例25.6%、24.2%和22%,P=0.96)。结论 CP-VI基础上CFAEs消融的房颤终止比例高于单纯线性消融,但低于联合应用CFAEs消融和Linear消融。尽管如此,三组术后二次消融比例和随访成功率无显著性差异。

Objective To evaluate the efficiency of substrate modification usin$ complex fraetionated atrial electrograms （CFAEs） ablation and/or linear ablation following circumferential pulmonary vein isolation （CPVI） on patients with chronic atrial fibrillation （AF）. Methods One hundred and fifty-six patients （ 89 males, mean age 56. 9 ＋ 7.7 years and mean AF duration 2.5 ±2.3 years） with chronic AF were retrospectively analyzed. They were divided into three groups according to the evolution of ablation strategies ： CPVI ＋ CFAEs, CPVI ＋ Linear and CPVI ＋ CFAEs ＋ Linear. The procedural parameters such as proportion of AF termination and subsequent clinical effectiveness were compared among three groups. Results There was statistically significant difference on the total procedural time among three group （ 160±14min vs 178±9min vs 241 v8min, P 〈0.01 ）. The proportion of AF termination was significantly higher in CPVI ＋ CFAEs group （52.7%） than that in CPVI ＋ Linear group （ 18.4% ） （ P 〈 0. 001 ）, but was significantly lower than that in CPVI ＋ CFAEs ＋ Linear group （73.1% ） （ P = 0.03 ）. However, the proportion of reablation was comparable （47.3 % vs 51% vs 38.5%, P =0. 43）. At the end of 9.5±1.8 months of follow-up, the proportion of atrial tacbyarrhyihmia-free among three groups was similar （70. 9% vs 67.3% vs 78.8%, P =O. 41 ）. Conclusions On the basis of CPVI, the proportion of AF termination is higher in CFAEs ablation than that that iu linear ablation, but is lower than that in combination of CFAEs and linear ablation. However, the clinical effectiveness among three groups remained comparable.