持续性心房颤动个体化射频导管消融的临床研究

Individual catheter ablation strategy for persistent atrial fibrillation

目的 探讨持续性心房颤动（房颤）的个体化导管消融策略的安全性及有效性,并比较其与常规2C3L消融策略的差异性.方法 选自2012年8月至2014年3月在广东省人民医院住院的80例持续性房颤患者按照消融策略的不同分为研究组（个体化方法,n=40）和对照组（2C3L方法,n=40）.研究组消融策略：首先完成双侧环肺静脉电隔离（CPVI）,然后根据左心房电压基质标测结果进行个体化消融.对照组消融策略：完成双侧CPVI后,逐步完成顶部线、二尖瓣峡部和三尖瓣峡部的线性消融.结果 相比于对照组,研究组的手术时间[（96.3±12.9）min 对（144.1±36.7）min,P〈 0.001]、消融时间[（37.2±9.0）min 对（51.8±12.0）min,P〈 0.001]和X线曝光时间[（11.9±4.1）min对（16.2±5.0）min,P〈0.001]均短于对照组差异有统计学意义.共随访（24±5）个月,单次消融后两组的窦性心律维持率均差异无统计学意义（62.5％对60.0％,P=0.89）.结论 对于持续性房颤患者,个体化消融策略的消融成功率与2C3L策略相似,但手术时间、消融时间和X线曝光时间更少.

Objective This prospective clinical trial was designed to evaluate the efficacy of an ablation strategy,namely individual,in the treatment of persistent atrial fibrillation（AF）,and to compare its efficacy with that of the 2C3L approach,which has been acknowledged as a promising ablation technique for persistent AF.Methods The individual strategy is a new ablation approach consisting of bilateral circumferential pulmonary vein antrum isolation（CPVI）and ablation of low voltage zone was performed laterally according the results of voltage mapping.Eighty patients with persistent AF were randomized to undergo ablation by using the individual or the 2C3L technique（n=40,respectively）.Results The procedure[（96.3±12.9）min vs.（144.1±36.7）min],fluoroscopy[（11.9±4.1）min vs.（16.2±5.0）min],and radiofrequency（RF）[（37.2±9.0）min vs.（51.8±12.0）min]time were significantly shorter in the individual group（all P 〈 0.001）.At（24±5）months after the first procedure,62.5%and60.0%of patients from the individual group and the 2C3L group were in SR off AAD（P=0.89）,respectively.Conclusions For catheter ablation of persistent AF,the individual approach is a new approach associated with clinical efficacy similar to that of the 2C3L strategy but with less RF delivery,fewer X-ray exposure,and shorter procedural time.