肺动脉参考导管在心房颤动射频消融术中的应用

Application of positional reference catheter in pulmonary artery in radiofrequency ablation of atrial fibrillation by NavX system

目的与传统冠状静脉窦导管定标技术对比,评价肺动脉导管定标技术在NavX系统（美国圣犹达公司）指导下行心房颤动（房颤）导管射频消融术中应用的可行性及安全性.方法2012年1月至2013年12月宁波市第一医院心内科连续收治行导管射频消融术的304例房颤患者,根据随机数字软件分组后采用肺动脉导管定标技术（A组,152例）或冠状静脉窦（CS）导管定标技术（B组,152例）于NavX系统指导下行房颤射频消融手术.消融策略：所有患者均先行环肺静脉电隔离术,持续性房颤患者加行左心房碎裂电位消融及左心房顶部、二尖瓣峡部、下腔静脉-三尖瓣峡部线性消融,必要时再加行上腔静脉、CS口部及窦内消融.结果术中A组平均建模次数[1～2（1.09±0.28）次对1～3（1.18±0.44）次,P＜0.05）及X线曝光时间[3.00～23.26（9.32±3.77）min对253～39.37（11.22±6.83）min,P＜0.01）均少于B组.术后随访,两组总体消融成功率（77.63％对68.42％,P＞0.05）及阵发性房颤消融成功率（80.95％对77.94％,P＞0.05）差异无统计学意义,但肺动脉导管定标组的持续性房颤消融成功率更高（75.28％对60.71％,P＜0.05）.两组手术相关并发症发生率差异无统计学意义（P＞0.05）.结论应用肺动脉导管定标技术在NavX系统指导下行房颤射频消融术,能显著减少模型移位及重建,减少X线曝光时间,并可能提高持续性房颤的消融成功率.

Objective The study was to investigate the feasibility and safety of the application of positional reference catheter（PRC） in pulmonary artery（PA） in radiofrequency ablation of atrial fibrillation（AF） by the NavX electroanatomic system compared with the conventional PRC in the coronary sinus （CS）.Methods A total of 304 consecutive patients with AF who underwent the first catheter ablation from January 2012 to December 2013 in Cardiology Department of Ningho First Hospital were randomized into group A （n=152,PRC in PA） or group B （n=152,PRC in CS）.Circumferential pulmonary vein isolation were deployed in all subjects while additional complex fractionated electrogram ablation and linear ablation in the roof of LA,mitral isthmus,cavo-tricuspid isthmus as well as superior vena cava or CS if necessary in patients with persistent AF.Results The reconstructive frequency [1-2（1.09± 0.28） vs.1-3（1.18±0.44）,P〈0.05） and the fluoroscopy time [3.00-23.26（9.32±3.77） min vs.2.53-39.37 （11.22±6.83） min,P〈0.01） were obviously lower in group A than those in group B.The success rates of total patients （77.63% vs.68.42%,P〉0.05） and paroxysmal AF cases （80.95% vs.77.94%,P〉0.05） were similar between two groups during the follow-up.But the success rate of persistent AF cases in group A was higher compared with that in group B （75.28% vs.60.71%,P〈0.05）.No significant differences existed in complication rates.Conclusion The novel reference technique with catheter in PA may reduce the possibility of model drift and reconstrucdon,as well as the fluoroscopy exposure and improve the success rate in persistent cases in the radiofrequency ablation of AF guided by the NavX electroanatomic system.