阵发性心房颤动合并左心房扩大患者单纯环肺静脉隔离和加行线性消融的长期疗效对比

Comparison of long-term outcomes of pulmonary vein isolation with or without additional linear ablation in paroxysmal atrial fibrillation patients with left atrial enlargement

目的 比较环肺静脉隔离（CPVI）和CPVI＋线性消融治疗阵发性心房颤动合并左心房扩大患者的长期疗效.方法 入选左心房内径≥40 mm的阵发性心房颤动患者188例,根据术中结果分为CPVI组（132例,CPVI后恢复窦性心律且结束手术时未诱发心房颤动心律失常者）和CPVI＋线性消融组（56例,CPVI后心房颤动未终止或诱发房性心律失常的患者继续行二尖瓣环峡部线、左心房顶部线和下腔静脉-三尖瓣环峡部线消融）.随访至术后3年.比较2组患者左心房内径、左心室射血分数（LVEF）、单次消融术中结果及并发症.结果 CPVI＋线性消融组左心房内径大于CPVI组,差异有统计学意义[（45 ±5） mm比（43 ±3） mm,P=0.011],LVEF小于CPVI组,差异有统计学意义[（61±8）％比（64±9）％,P =0.045].CPVI＋线性消融组手术时间和X线透视时间明显长于CPVI组[分别为（205 ± 67） min比（142 ±45） min;（40±16） min比（28 ±21）min,均P＜0.01].术后1年,CPVI＋线性消融组单次消融成功率低于CPVI组[66.1％ （37/56）比79.5％ （105/132）,P=0.047],但术后3年2组单次消融成功率差异无统计学意义[（57.7％ （32/56）比59.2％ （78/132）,P=0.857].术后3年成功率差异无统计学意义[60.9％ （28/46）比59.2％ （78/132）,P=0.755].结论 阵发性心房颤动合并左心房扩大患者在CPVI基础上加行线性消融近期成功率低于单纯CPVI,但远期成功率相当.

Objective To compare the long-term outcomes of circumferential pulmonary vein isolation （CPVI） and CPVI plus linear ablation in paroxysmal atrial fibrillation（PAF） patients with left atrium（LA） enlargement.Methods One hundred and eighty-eight patients of PAF with LA dimention≥40 mm were included,and CPVI was performed followed by burst pacing induction.CPVI group included 132 cases with sinus rhythm restored after CPVI and no arrhythmia induced.CPVI ＋ linear ablation group included 56 cases among whom AF was not terminated or atrial arrhythmia was induced with mitral isthmus,LA roofline and cavo-tricuspid isthmus ablated.All patients were followed up for 3 years.Results Procedure time [（205 ± 67） min vs （142 ± 45） min,P 〈0.01] and X-ray exposure time [（40 ± 16） min vs （28 ± 21） min,P 〈 0.01] were significantly longer in CPVI ＋ linear ablation group.One-year successful rate after single procedure was lower in CPVI ＋ linear group [66.1% （37/56） vs 79.5 % （105/132）,P =0.047],but no significant difference was observed regarding 3-year successful rate after single procedure [60.9% （28/46） vs 59.2% （78/132）,P =0.857],as well as 3-year cumulative successful rate（69.2% vs 66.7%,P =0.755）.Conclusions In PAF patients with LA enlargement,the shortterm successful rate is lower in patients undergoing CPVI plus additional linear ablation than that in CPVI,but the long-term outcomes are equivalent.