冷冻球囊消融和射频导管消融在心房颤动患者中应用的对比分析

Comparison of cryoballoon ablation and radiofrequency catheter ablation of paroxysmal atrial fibrillation

目的比较心房颤动患者冷冻球囊消融(下称冷冻消融)与射频导管消融(下称射频消融)的操作过程以及两者对心肌组织的损伤程度和炎症反应的差异。方法选择经药物治疗无效的阵发性心房颤动患者80例,根据选择的消融方式分为冷冻消融组和射频消融组,每组40例。比较两组消融时间、手术时间和透视时间,检测术前及术后即刻、6、12、24h的肌酸激酶同工酶(CK-MB)、肌钙蛋白I(Tn I),术前和术后24h的C反应蛋白(CRP)以及体温变化。结果冷冻消融组患者消融时间[(37.2±7.0)min]和手术时间[(111.6±19.2)min]均短于射频消融组[(42.5±13.2)min、(135.5±35.0)min],透视时间[(22.4±8.1)min]长于射频消融组[(13.1±3.2)min],差异均有统计学意义(P<0.05或0.01)。冷冻消融组CK-MB、Tn I及CRP均高于射频消融组。两组患者术后发热患者比例和发热程度差异均无统计学意义(均P>0.05)。结论心房颤动冷冻消融的消融时间短而心肌损伤明显。

Objective To compare the performance of cryoballoon ablation（CBA） and radiofrequency ablation（RFCA）of atrial fibrillation and their different effects on myocardial injury and inflammation. Methods Eighty patients withdrug-resistant paroxysmal atrial fibrillation were enrolled. Half of them underwent CBA and other half underwent RFCA.Ablation duration, procedural time and fluoroscopy time were compared. Creatinine kinase-MB （CK-MB） and troponinI（TnI） were measured before and at 0,6,12,24 hours after the procedure. C-reactive protein （CRP）and body temperaturewere measured before and at 24 hours after the procedure. Results The ablation time and procedural durationdecreased and fluoroscopy time increased in CBA group[（37.2±7.0）min, （111.6±19.2）min, （22.4±8.1）min] compared withRFCA group[（42.5±13.2）min, （135.5±35.0）min, （13.1±3.2）min]（P〈0.05 或 0.01）. CK-MB, TnI and CRP levels weresignificantly higher in CBA group than RFCA group. There was no significant difference of the incidence and degree offever after procedures between the two groups. Conclusion CBA of atrial fibrillation may shorten ablation time withobvious myocardial lesion.