冷冻球囊消融治疗阵发性心房颤动的临床应用及安全性

Application of cryoballoon ablation in patients with paroxysmal atrial fibrillation

目的 评价冷冻球囊消融（cryoballoon-based ablation,CBA）在阵发性心房颤动（房颤）治疗中的应用,分析其有效性、安全性及相关临床参数.方法 选择2013年12月至2014年12月在上海交通大学医学院附属瑞金医院接受CBA的阵发性房颤患者107例,其中男72例,女35例,年龄19 ～ 80（59.63±10.11）岁.观察CBA的安全性、有效性、手术时间及随访数据.结果 106例（99.1％）的患者都应用冷冻球囊完成房颤消融手术（达到3根及以上肺静脉电隔离）;术中4根肺静脉隔离率97.2％;手术及围术期,出现缺血性脑卒中、动静脉瘘各1例,膈神经受损2例.术后6个月随访时,86.0％的患者维持窦性心律.手术后急性期无房颤的患者在6个月时能维持窦性心律的比例显著增高（94.4％对64.3％,P=0.021）.结论 CBA可有效安全地应用于阵发性房颤肺静脉隔离.

Objective To evaluate the application of cryoballoon-based ablation in paroxysmal atrial fibrillation （AF） patients.Methods A total of 107 patients with paroxysmal AF,who underwent cryoballoon ablation,were enrolled in the study.They were followed up at three months and six months after ablation.Results One hundred and six patients （99.1％）achieved three or more pulmonary vein（PV） isolation and 97.2％ patients achieved isolation of all four PV.Ischemic stroke and arterio-venous fistula were observed in one patient respectively.Two patients had phrenic nerve palsy.At six months follow-up,86.0％ patients were free of AF.Patients without AF recurrence in the first three days after ablation procedure had a higher rate of sinus rhythm compared with the patients who had AF recurrence in the first three days （94.4％ vs.64.3％,P=0.021）.Conclusion Cryoballoon ablation can be effectively and safely used in paroxysmal AF patients.