2013-2015年湖北省心律失常导管消融手术的应用趋势

Current application trend in the catheter ablation of arrhythmias in Hubei province from 2013 to 2015

目的分析2013—2015年湖北地区心律失常导管消融手术的应用趋势。方法提取2013—2015年湖北省心律失常导管消融手术量,并分析在阵发性室上性心动过速(PSVT)、心房颤动(房颤)、室性期前收缩(室早)和室性心动过速(室速)等疾病上的应用变化。结果 2013—2015年,湖北地区心律失常导管消融手术量3年的年增长率分别为13.1%、6.0%和6.7%,除PSVT手术量逐年下降外,其他心律失常的手术量均逐年增加。PSVT的常规标测技术应用逐年下降,而Carto和Ensite标测的应用逐年增加(P<0.01);3年间消融成功率均维持在96%左右,差异无统计学意义(P=0.16)。房颤以射频消融术为主,冷冻消融增长迅速,2015年达17.44%,3年间差异有统计学意义(P<0.01);标测以Carto为主,但Ensite标测逐年增加,3年间差异有统计学意义(P<0.01);环肺静脉电隔离即刻成功率在98%以上,3年间差异无统计学意义(P=0.34)。室早消融术的Carto和Ensite标测使用逐年增长,3年间差异有统计学意义(P<0.01);消融成功率稳步提高,2013—2015年分别为92.6%、94.9%和95.9%,差异有统计学意义(P=0.03)。室速消融术的常规标测应用逐年减少,而Carto应用逐年增加,3年间差异有统计学意义(P<0.05);消融成功率分别为87.4%、85.8%和89.2%,3年间差异无统计学意义(P=0.71)。结论既往3年,湖北地区心律失常疾病的消融治疗进入平稳发展期,消融手术质量呈逐年提高趋势,但室速的消融术开展仍十分不足,心脏性猝死的防治工作依然严峻。

Objective To analyze the trend of catheter ablation of arrhythmias in Hubei province from 2013 to 2015. Methods The data of catheter ablation of arrhythmias in Hubei province from 2013 to 2015 was collected to analyze the application trend of arrhythmia catheter ablation, including paroxysmal supraventricular tachycardia （ PSVT ）, atrial fibrillation （ AF ）, ventrieular premature beat （ VPB ） and ventrieular tachycardia（VT）. Results In 2013,2014 and 2015, the increasing rate of the catheter ablation in Hubei province was 13.1% ,6.0% and 6. 7% respectively. Except for the decrease of PSVT,the volume of other arrhythmias increased year by year（ P 〈 0. 01 ）. For the ablation of PSVT, the proportion of conventional mapping declined while the Carto and Ensite mapping applications increased year by year（ P 〈 0. 01 ）. Success rate of ablation maintained around 96% without statistical difference（ P = 0. 16 ）. AF ablation account for majority of radiofrequency ablation and the use of cryoablation rapidly increased to 17.4% in 2015. Carto mapping remained the main procedure, but the use of Ensite mapping increased every year with a significant difference（P 〈0. 01 ）. Immediate success rates of electrical isolation of circumferential pulmonary vein were over 98 % without intergroup difference （P = 0. 34 ）. The application of Carto and Ensite mapping was gradually increased in the ablation of VPB （P 〈 0. 01 ） , and the success rates of catheter ablation were 92. 6% ,94. 9% , and 95.9% respectively （P = 0. 03 ） in 2013,2014, and 2015. The use of conventional mapping for VT decreased while the application of Carto increased（ P 〈 0. 05 ）. Success rate in each year was 87.4% ,85.8% ,and 89.2% respectively（P =0. 71 ）. Conclusions In the past 3 years,the development of catheter ablation of arrhythmias entered a stable period in Hubei province, and the quality of catheter ablation was gradually improved. However, the use of ablation on the treatment of VT and prevention of SCD still face to a challenge.