左房后壁双盒式消融策略治疗阵发心房颤动合并左房前后径扩大患者的疗效观察

The left atrial posterior wall dual box ablation strategy for paroxysmal atrial fibrillation patients with enlarged left atrial diameter

目的评价左房后壁双盒式消融(PWDB)术式对合并左房前后径(LAD)扩大阵发性心房颤动(简称房颤)患者的疗效。方法连续入选在本院行射频消融治疗的阵发性房颤合并LAD扩大患者65例,随机分为PWDB组(n=34)和肺静脉隔离(PVI)组(n=31)。PWDB组在右侧环肺静脉消融隔离后,自右侧消融环顶点行心房顶部线、左肺静脉嵴部和后壁线消融至右侧消融环底部,形成囊括右肺静脉和左房后壁大部的两个区域。PVI组沿双侧肺静脉前庭行电学隔离。对比观察两组临床一般情况、手术总时间、X线曝光时间、消融时间、围术期并发症例数。随访12个月,对比观察消融成功率、LAD变化和不良事件。结果两组临床一般情况对比无差异。与PVI组相比,PWDB组手术总时间[(168.8±20.8)min vs(140.3±22.5)min,P<0.001]和消融时间延长[(39.0±6.1)min vs(33.1±6.5)min,P<0.001)]。两组X线曝光时间[(21.6±4.3)min vs(20.1±3.5)min,P=0.132)]和围术期并发症事件(1例vs 0例,P=1.000)无差异。12个月随访期内,PWDB组26例(76.5%)维持窦性心律,PVI组17例(54.8%)维持窦性心律,差异有显著性(P=0.043)。两组间不良事件发生例数(2例vs 3例,P=0.663)无差异。对随访期内无复发患者进行亚组分析,LAD在PWDB组有减小趋势(P=0.001),PVI组未见明显变化(P=0.583)。结论对于合并LAD扩大的阵发房颤,PWDB术后12个月成功率显著高于PVI术式,值得临床推广应用。

Objective To compare the efficacy of left atrial posterior wall dual box ablation（PWDB）and pulmonary vein isolation（PVI）ablation for paroxysmal atrial fibrillation（AF）patients with left atrial diameter（LAD）enlarged. Method Sixty-five paroxysmal AF patients with LAD enlarged,who received treatment in affiliated hospital of the Armed Police Force Logistics College,were enrolled and randomly divided into PWDB group（n=34）and PVI group（n=31）.In PWDB group,circumferential right pulmonary vein isolation was performed as a first step and subsequently underwent linear radiofrequency lesions from the superior pole of the right superior pulmonary veins to the left,creating a transverse roof line plus an left pulmonary vein anterior antrum line and an additional transverse linear lesion linking the inferior aspect of the inferior pulmonary veins to complete dual-box ablation on the left atrial posterior wall.In PVI group,bilateral PVI alone by circumferential ablation was done.The clinical general data,total procedure time,X-ray exposure time,ablation time and the cases of complication were observed.During a 12-month follow-up period,the success rate of ablation,LAD changes and adverse events were compared between both groups. Results The clinical general data had no difference in both groups.Compared to PVI group,the total time[（168.8 ± 20.8）min vs（140.3±22.5）min,P0.001],ablation time[（39.0±6.1）min vs（33.1±6.5）min,P0.001]were prolonged in PWDB group.X-ray exposure time[（21.6±4.3）min vs（20.1±3.5）min,P=0.132]and case of complication（1 case vs 0 case,P=1.000）had no difference.26 patients（76.5%）in PWDB group and 17 patients（54.8%）in PVI group were free from AF during the follow-up time,the difference was statistically significant（P=0.043）.The adverse events had no difference（2 cases vs 3 cases,P =0.663）.The LAD of those patients maintaining sinus rhythm within follow-up period in PWDB group had a decreasing trend（P =0.001）,Which had no significant changes in the control group（P=0.583）. Conclusion The PWDB strategy is safe and more effective than PVI alone for paroxysmal AF patients with enlarged LAD.