AI指导下零射线射频消融治疗阵发性心房颤动的初步研究

Preliminary study of zero X-ray radiofrequency ablation under the guidance of ablation index in the treatment of paroxysmal atrial fibrillation

目的:探讨消融指数(AI)指导下零射线射频消融治疗阵发性心房颤动(房颤)的可行性、安全性及临床疗效。方法:选取2017年9-12月于浙江大学医学院附属第二医院心血管内科行AI指导下阵发性房颤零射线射频消融术患者15例作为实验组,选取同期行常规阵发性房颤射频消融术患者15例作为对照组。实验组借助CARTO 3三维电解剖标测系统,全程零射线完成房间隔穿刺、左心房建模及AI指导下双侧环肺静脉电隔离(PVI)。而对照组在X线透视下完成房间隔穿刺、左心房Lasso建模及冷盐水灌注导管消融。分别观察术中两组的单圈PVI隔离率、双侧PVI成功率、消融时间、手术总时间、X线曝光时间、血管及心包填塞等并发症的发生情况。结果:与常规房颤射频消融术相比,AI指导下零射线射频消融的单圈PVI隔离率高,消融时间明显缩短。两组患者的双侧PVI成功率和手术总时间基本一致。两组患者均未发生心包填塞、血栓栓塞、血肿、围手术期死亡等并发症。结论:AI指导下零射线射频消融治疗阵发性心房颤动手术成功率高,无放射性损害,安全可行。

Objective：To investigate the feasibility,safety and clinical efficacy of radiofrequency ablation for paroxysmal atrial fibrillation（PAF）under the guidance of ablation index（AI）.Method：A toal of 15 patients with PAF and radiofrequency ablation guided by AI were selected in the deparment of Cardiology,the Second Affiliated Hospital of Zhejiang University School of Medicine from September 2017 to December 2017,as the experimental group in our study.The 15 patients with PAF in the same period were treated by conventional radiofrequency ablation as control group.The experimental group used the CARTO 3 three-dimensional electroanatomical mapping system to complete atrial septal puncture,left atrial modeling and AI guided pulmonary vein isolation（PVI）under the zero X-ray.In the control group,the atrial septum puncture,the Lasso modeling of the left atrium and the catheter ablation by Thermocool were performed under X-ray fluoroscopy.The two groups of single loop PVI rate,bilateral PVI success rate,ablation time,total operation time,X-ray exposure time,blood vessel and cardiac tamponade were observed respectively.Result：Compared with the conventional radiofrequency ablation of AF,the single loop PVI rate of Zero X-ray radiofrequency ablation under the guidance of AI was higher and the ablation time was significantly shorter.The success rate of bilateral PVI and the total operation time was basically the same in the two groups.There were no complications such as pericardial tamponade,thromboembolism,hematoma and perioperative death occurred in the two groups.Conclusion：Zero X-ray radiofrequency ablation under the guidance of AI has a high success rate in the treatment of paroxysmal atrial fibrillation,and it is safe and feasible without radiation damage.