采用高功率短时程消融治疗心房颤动的疗效及安全性

The effect and safety of high-power and short-duration versus low-power and long duration on ablation of atrial fibrillation

目的探讨高功率短时程(HPSD)消融心房颤动(简称房颤)的效果及安全性。方法2017年4月至2019年4月拟行导管射频消融的房颤患者,随机分为HPSD组和低功率长时程(LPLD)组,两组均使用压力导管和功率控制模式,灌注流速15~17 ml/min。HPSD组:消融功率50 W,压力5~15 g,前壁或底部消融7~9 s,后壁或顶部消融5~7s;LPLD组:功率25~35 W,压力10~20 g,前壁和底部25~35 s,后壁或顶部20~25 s。消融终点为双侧肺静脉隔离,必要时线性消融、前庭或瓣环邻近区域碎裂电位消融、或基质消融。比较两组的手术成功率、并发症发生率、手术时间、X线曝光时间。结果总计92例房颤患者完成消融手术,LPLD组和HPSD组各有46例,两组基线资料无差异。91例完成术后6个月随访,1例失访,比较LPLD组和HPSD组:①手术成功率:单次消融维持窦性心律者分别为35例和36例(76.1%vs 80.0%,P>0.05),二次消融房性心动过速或心房扑动后维持窦性心律者分别为37例和38例(80.4%vs 84.4%,P>0.05);②手术时间:分别为(173.6±53.3)min和(139.4±50.7)min(P<0.05),在持续性房颤分别为(206.3±46.0)min和(155±61.8)min(P<0.05);③透视时间:中位数/四分位数分别为8(3,11)min和7(3,10)min(P>0.05);④射线剂量:中位数/四分位数分别为15(5,25)mG和14(5,24)mG(P>0.05)。两组一般并发症、严重并发症和即刻肺静脉隔离成功率均无明显差异。结论与LPLD组相比,HPSD组可明显缩短房颤消融手术时间,且安全有效。

Objective To investigate the efficacy,efficiency,and safety of atrial fibrillation ablation using high-power and short-duration(HPSD) method. Methods Patients who were admitted for atrial fibrillation(AF) ablation were randomized into HPSD study group and low-power and long-duration group(LPLD). Both groups used irrigated force-sensing catheters and power-control ablation. The patients in HPSD were ablated with HPSD method,in which high-power(50 Walt) and short-duration(5-9 seconds) were utilized and the contact force was adjusted within 5-15 gram;the patients in LPLD group were ablated with traditional LPLD method, in which low power(25-35 Walt) and long duration(20-35 seconds) was used and contact force was adjusted within 10-20 gram. The ablation strategy in both groups were the same including pulmonary vein isolation as the cornerstone plus necessary linear ablation, complex fractionated atrial electrograms close to antrum or annulus, or substrate modification. The procedural success and occurrence of complication rate, procedure time, fluoroscopic time were compared between the two groups. Results Ninety two patients with AF were enrolled and each group had 46 patients.There were no significance between the two groups as to the proportion of persistent AF,age,left atrial size,and ejection fraction.Ninety one patients completed the six-month follow-up.The LPLD group were compared with HPSD group:(1)35 and 36 cases maintained sinus rhythm respectively during follow-up after single ablation(76.1% vs 80.0%,P>0.05);(2)procedure time was(173.6±53.3)min and(139.4±50.7)min respectively (P<0.05);(3)the median/quartile fluoroscopic time was 8(3,11)min and 7(3,10)min respectively(P>0.05);(4)the median/quartileradiation dose was 15(5,25)mG and 14(5,24)mG respectively(P>0.05).There was no significant between-group difference as to general or severe complications or immediate success rate offirst-passisolation.Conclusions HPSD method is not inferior to traditional method using LPLD method as to procedure complications and success rate;and it apparently reduces procedure time.