消融指数与阵发型心房颤动复发率的相关性研究

The ablation index and the recurrence rate of paroxysmal atrial fibrillation

目的探讨消融指数(AI)的应用对心房颤动环肺静脉电隔离术后残存传导漏洞和复发率的影响。方法回顾性收集2016年1月至2017年7月在上海市第一人民医院心内科接受射频消融术的心房颤动患者,采集围手术期及术后随访临床资料,以压力导管(CF)为对照组,利用Kaplan-Meier曲线和多因素回顾模型分析消融指数的应用与环肺静脉术后残存传导漏洞和术后复发率的关系。结果本研究纳入患者400例,AI组平均年龄(64±10)岁和CF组平均年龄(65±9)岁。AI组总的手术时间和X线曝光时间均明显短于CF组[(142±27)min比(155±33)min,P=0.015;(7.4±6.4)min比(13.6±8.9min),P<0.001]。AI组残存传导漏洞数明显小于CF组(1.7±1.6比2.6±2.1,P<0.05)。心房快速心律失常(ATA)复发率AI组明显低于CF组[20/200(10%)比35/200(17.5%),P<0.01]。结论消融指数的应用缩短了手术时间,减少了残存传导漏洞和1年心房快速心律失常复发率。

Objective To evaluate the impact of the application of ablation index(AI)on the residual conduction gaps and recurrence rate after CPVI of atrial fibrillation(AF).Methods A respective study of consecutive AF ablation procedures at Shanghai General Hospital between January 2016 to July 2017 was made.The patients were divided into AI group and CF group.Clinical data were collected to analyze the residual conduction gaps.Kaplan-Meier curve and Logistic regression analyses were conducted to evaluate the association between the use of AI and recurrence rate.Results 400 patients were involved in this study,including AI group[mean age(64±10)years]and CF group[mean age(65±9)years].Total procedure and fluoroscopy times were both significantly shorter in the AI group than in the CF group[(142±27)min vs.(155±33)min,P=0.015 and(7.4±6.4)min vs.(13.6±8.9)min,P<0.001,respectively].The number of residual conduction gaps of AI group was significantly less than CF group(1.7±1.6 vs.2.6±2.1,P<0.05).Atrial tachyarrhythmia recurrence was significantly lower in AI group[20/200(10%)]than in CF group[35/200(17.5%)](P<0.01).Conclusion The application of ablation index would shorten the procedure time,reduce residual conduction gaps and one-year tachyarrhythmia recurrence rate.