冷冻球囊与射频消融对心房颤动患者心肌损伤程度的比较

The comparison and clinical significance of myocardial injury between the atrial fibrillation patients treated with radiofrequency ablation and cryoballoon ablation

目的通过比较冷冻球囊与射频消融术对心房颤动(简称房颤)患者心肌损伤程度的差异,探讨其对术后房颤急性期复发率的影响。方法 45例房颤患者按照消融术式的不同分为两组:射频组(n=20)与冷冻组(n=25)。于术前、术后6~12h内及术后3~5d内对患者抽血检测肌钙蛋白I(cTnI)水平,并在术后3~5d内行24h动态心电图检查。结果 (1)与术前相比,射频组与冷冻组两组术后6~12h内cTnI水平均显著升高[1.59(0.82,1.95)μg/L vs 0.01(0.01,0.01)μg/L]vs[7.16(4.23,9.31)μg/L vs 0.01(0.01,0.01)μg/L,P均<0.001];射频组与冷冻组术后3~5d内较术后6~12h内cTnI水平明显下降[(0.09(0.03,0.29)μg/L vs 1.59(0.82,1.95)μg/L]vs[0.45(0.13,0.86)μg/L vs 7.16(4.23,9.31)μg/L,P均<0.001];(2)与射频组相比,冷冻组术后6~12h内、术后3~5d内cTnI水平明显升高(P<0.01),而术前两组间cTnI水平无明显差别;(3)术后急性期冷冻组与射频组房颤复发率无差别(32%vs 25%,P=0.607)。结论冷冻球囊消融术对房颤患者心肌损伤程度大于射频消融术,但对房颤急性期复发率无影响。

Objective To compare the degree of myocardial injury between radiofrequency（RF）, and cryoballon （CB）, and to explore the possible clinical significance of it. Methods Forty five patients with atrial fibrillation （AF）, were treated with pulmonary vein isolation and were divided into two groups according to different ablation procedures： RF group（n=20） and CB group（n = 25）. Samples of cardiac troponin I （cTnl） were collected before the operation, within 6- 12 h after the operation and within 3- 5 days after the operation. Each patient was performed with 12 leads ECG hoher within 3 5 days after the operation. Results （1）Compared with the preoperative cTnI level, the cTnI value both had an increase in the RF[1.59（0.82,1.95）μg /L vs 0.01（0.01,0.01）μg /L] group and CB group[7.16（4.23,9.31）μg/L vs 0.01（0.01,0.01）μg /L] within 6-12 h after the operation, and the cTnI value both had a decrease in the RF[0.09（0.03,0.29）μg /L vs 1.59（0.82,1.95）] group and CB group[0.45（0.13,0. 86）μg /L vs 7.16（4.23,9.31）μg /L] within 3-5 days after the operation; （2）Compared with the RF group, the CB group had a higher increase in the cTnI level no matter within 6-12 h or 3-5 days after the operation, and the difference between the two groups was statistically significant. （3）No statistically significant difference was shown in the recurrence rate between the RF group and CB group（ 25% vs 32%, P =0.607）during the acute stage after the operation. Conclusion Compared with the radiofrequency ablation, the degree of myocardial iniury is greater in the cryoablation ablation, and there is no difference in the recurrence of the post-procedure acute phase between the two procedure.