应用压力感知消融导管治疗阵发性心房颤动的疗效

The long-term outcome of contact force catheter in treating patients with paroxysmal atrial fibrillation.

目的报道应用压力感知消融导管进行环肺静脉隔离术(CPVI)治疗阵发性心房颤动(简称房颤)的远期疗效。方法总计连续206例非瓣膜病性阵发性房颤患者,其中前103例接受非压力感知的冷盐水灌注射频导管消融(对照组),后103例接受压力感知的冷盐水灌注射频导管消融(ST组)。两组的消融策略均为三维电解剖标测系统(CARTO)指导下的CPVI。对比两组放电时间、X线透视时间,每例患者的随访时间均为18个月。结果随访18个月,ST组(92/103)的成功率显著高于对照组(76/103)成功率(89.3%vs 73.8%,P=0.004)。14例术后复发患者接受了再次导管消融术,其中ST导管组5例,对照导管组9例。前者的肺静脉传导远期恢复率显著低于后者[30%(6/20)vs 63.9%(23/36),P=0.025]。对影响单次消融手术成功率的多因素进行分析显示,术中使用ST导管为影响预后的独立相关因素(P=0.006;OR 2.9;95%CI 1.35~6.23)。结论和非压力感知冷盐水灌注消融导管相比,使用具有压力感知功能的冷盐水灌注消融导管对阵发性房颤患者进行CPVI具有更低的肺静脉传导恢复率和更高的随访成功率。

Objective To report the long-term outcome of circumferential pulmonary vein isolation（CPVI） using the contact force-sensing catheter in treating patients with paroxysmal atrial fibrillation （AF）. Methods A total of 206 consecutive patients with non-valvar paroxysmal AF were included in this study.In the former 103 patients,CP- VI guided by a three-dimensional electroanatomic mapping system （CARTO） was performed by using the conven- tional irrigated ablation catheter（control group）, whereas in latter 103 patients, contact force-sensing irrigated abla- tion catheter （SmartTouchTM catheter） was used （ST group）.All patients from each group under went general characteristics,ablation time and X-ray exposure time were collected. The follow-up duration was 18 months for all patients enrolled. Results During the follow-up period,the success rate after the index procedure in the ST group （92/103）was significantly higher than that in the control group（76/103）（89.3% vs73.8% ,P =0.004）.14 patients （5 in ST group and 9 in control group） with recurrent atrial tachyarrhythmia underwent repeat ablation procedures. Pulmonary vein-left atrium conduction reconnection was less frequently observed in the ST group as compared that in the control group [30% （6/20） vs 63.9% （23/36）,P =0.025]. Multivariable Cox analysis showed that intra-pro- eedural use of the contact force-sensing catheter was an independent predictor of AF recurrence （P =0.006 ;OR = 2. 9 ; 95% CI 1.35 = 6.23）. Conclusion In paroxysmal AF patients who undergo CPVI, intra-procedural use of the contact force-sensing ablation catheter may reduce the chronic pulmonary vein reconnection rate and improve the long-termsuccess rate as compared with the conventional ablation catheter.