CARTO系统引导下导管消融治疗老年心房颤动患者50例临床疗效及安全性分析

Clinical efficacy and safety of CARTO-guided ablation for the elderly with atrial fibrillation：analysis of 50 cases

目的：分析在CARTO系统引导下以环肺静脉口消融术为核心联合其他消融术式导管消融治疗老年心房颤动（房颤）的疗效和安全性，并分析其术后复发的危险因素。方法于2009年7月至2011年7月在解放军第252医院住院并随访接受导管射频消融治疗的50例老年房颤患者，男37例，女13例，年龄60～76（66.78±4.09）岁。其中阵发性房颤43例，持续性房颤5例，永久性房颤（＜2年）2例。采取CARTO三维标测系统指导下以环肺静脉口消融术为核心联合其他术式导管射频消融治疗，消融的主要终点为肺静脉完全电隔离。术后连续跟踪随访12个月，观察手术的成功率、复发率、复发的相关因素分析和并发症发生情况。结果50例患者术后即刻成功率为100%。术后随访显示，术后1年消融成功率为80%。术后发生心包填塞1例（2%），经心包穿刺置管术后缓解；术后发生无压塞症状的心包少量积液2例（4%），术后出现双侧少量渗出性胸腔积液1例（2%）；术后穿刺部位血肿2例（4%）。射频消融术后6个月，窦性心律维持成功的（成功组）40例患者，心脏彩超检查显示左房内径（LAD）均有不同程度的缩小，而窦性心律未能维持的（复发组）10例患者，LAD无明显变化；两组治疗前后平均LAD差值差异具有统计学意义[（4.64±1.12） vs （0.40±0.61）mm，P＜0.01]，但两组患者的左室射血分数较术前均无明显变化。术后12个月，共复发10例（20%），其中2例（4%）为永久性房颤患者，3例（6%）为持续性房颤患者，5例（10%）为阵发性房颤患者。老年持续性房颤、永久性房颤和术前LAD是房颤经导管射频消融术后复发的危险因素。结论 CARTO三维标测系统指导下导管射频消融治疗老年房颤是安全有效的。

Objective To analyze the efficacy and safety of the procedures dominated by circumferential pulmonary vein ablation and combined with other catheter ablation approaches, guided by CARTO system in the treatment of the elderly atrial fibrillation （AF）, and also to analyze the risk factors for recurrence. Methods A total of 50 elderly AF patients admitted in our department from July 2009 to July 2011 were recruited in this study. There were 37 males and 13 females, with age ranging from 60 to 76 （66.78±4.09） years. There were 43 cases of paroxysmal AF, 5 cases of persistent AF, and 2 cases of permanent AF （〈2 years）. A procedure dominated by circumferential pulmonary vein ablation and supplemented by other ablation strategies was applied under the guidance of CARTO system, and the primary endpoint of ablation was complete isolation of pulmonary vein. After a continuous follow-up for 12 months after the surgery, the surgical success rate, recurrence rate, recurrence-related factors and the incidence of complications were analyzed. Results The success rate of 50 patients achieved 100%immediately after the surgery, and the rate reduced to 80%in postoperative follow-up of 1 year after ablation. One case （2%） suffered from cardiac tamponade, which was relieved by cardiac catheterization. Two cases （4%） had pericardial effusion without tamponade symptoms, 1 （2%） had bilateral exudative pleural effusion, and 2 （4%） experienced hematoma at the puncture site. In 6 months after the radiofrequency ablation, 40 patients maintained sinus rhythm successfully （success group） and got left atrial diameter （LAD） reduced in size at various extents by cardiac ultrasound examination. However, no significant change in LAD was observed in the 10 patients who failed to maintain sinus rhythm （recurrence group）. The mean difference of LAD before and after treatment was （4.64±1.12）mm in success group and （0.40±0.61）mm in recurrence group （P〈0.01）. The left ventricular ejection fraction in the both groups remained no significant change before and after surgeries. In 12 months after surgery, 10 cases （20%） suffered recurrence in total, and 2 of them （4%） were permanent AF, 3 （6%） of persistent AF, and 5 （10%） of paroxysmal AF. The elderly persistent AF, permanent AF and preoperative LAD were risk factors for recurrence after radiofrequency catheter ablation. Conclusion CARTO-guided radiofrequency catheter ablation is safe and efficient in the treatment of the elderly AF.