应用新型肺静脉消融导管进行心房颤动肺静脉隔离术

Application of new pulmonary vein ablation catheter for pulmonary vein isolation in patients with atrial fibrillation

目的:评估环状标测与功率比式多极射频能量释放相结合的新型多极肺静脉消融导管(PVAC),在心房颤动(房颤)消融术中应用的可行性和安全性。方法:共入选47例有症状的房颤患者,其中32例为阵发性房颤(PAF组),15例为持续性房颤(PSF组),应用PVAC进行肺静脉隔离术。结果:介入手术时间平均(126.4±29.5)min[PAF组:(123.7±15.7)min,PSF组:(132.0±36.6)min,P>0.05];X线透视时间平均(30.3±11.3)min[PAF组:(29.4±9.8)min,PSF组:(32.3±14.2)min,P>0.05];PVAC消融时间平均(21.6±7.7)min[PAF组:(20.5±6.0)min,PSF组:(24.0±10.4)min,P>0.05]。在总共188支肺静脉中,有5支因其内未能检测到肺动脉电位而未实施消融术;其余183支实施消融术,其中172支(94.0%)被成功隔离。2例患者在术后第1天发现轻度的心包积液并在1周后自行吸收;所有患者均未发现肺静脉狭窄。随访(6±5)个月(3～21个月),32例(68.1%)症状明显改善或完全消失,29例(61.7%)成功维持窦性心律。结论:应用功率比式双极及单极射频能量的PVAC是一种安全可行的房颤消融新技术。

Objective：To evaluate the feasibility and safety of a novel multi-electrode pulmonary vein ablation catheter（PVAC） combining circular mapping and duty-cycled multi-electrode radiofrequency energy（RF） delivery for atrial fibrillation（Af）.Method：Forty-seven consecutive patients with symptomatic Af（32 cases for PAF and 15 cases for PSF） were enrolled.Result：Mean total procedural time was（126.4±29.5）min [（123.7±15.7）min in PAF patients and（132.0±36.6）min in PSF patients,P0.05].Mean fluoroscopy time was（30.3±11.3）min [（29.4±9.8）min in PAF patients and（32.3±14.2）min in PSF patients,P0.05].Mean PVAC ablation time was（21.6±7.7）min [（20.5±6.0）min in PAF patients and（24.0±10.4） min in PSF patients,P0.05].A total of 172 pulmonary veins（172/183,94.0%） were completely isolated.Two cases of mild pericardial effusion were detected on the first post-procedural day and absorbed in a week.No incidence of pulmonary vein stenosis was observed during the follow-up.After followed-up [mean（6±5） months,range 3-21 months],32（68.1%） patients′ symptoms significantly improved or disappeared completely,29（61.7%） patients were free from Af.Conclusion：Compared to conventional point-by-point lesions,the novel technology of PVAC using duty-cycled bipolar and unipolar RF energy and guided by 3D-ATG is a feasible,safe,and promising alternative.