损伤指数指导下心房颤动高功率消融临床研究

Clinical study of high power ablation of atrial fibrillation guided by lesion size index

目的评估损伤指数指导下高功率短时程心房颤动(下称房颤)消融的疗效及安全性。方法将房颤射频导管消融患者75例分为观察组和对照组,观察组采用高功率短时程消融方法,对照组采用常规功率方法消融,两组均在损伤指数指导下消融。损伤指数目标值前壁和顶部5.0~6.0,后壁和低部4.0~4.5。消融终点为达双侧肺静脉隔离,必要时线性消融、碎裂电位消融及基质消融。比较两组肺静脉单圈隔离率、并发症发生率、手术时间、X线曝光差异。结果常规功率组38例,高功率组37例,两组基线资料无差异(均P>0.05)。所有患者均完成6个月随访。常规功率组与高功率组的肺静脉单圈隔离成功率分别为71%和75.7%,单次消融3个月维持窦性心律者分别为33例(86.8%)和33例(86.5%),6个月维持窦性心律者分别为31例(81.6%)和32例(86.5%),消融时间阵发性房颤分别为(105.5±35.5)min和(88.6±31.7)min,持续性房颤分别为(115.6±40.8)min和(93.3±39.4)min,差异均有统计学意义(均P<0.01),X线透视时间和射线剂量两组间均无明显差异(均P>0.05)。两组患者均无严重并发症发生。结论损伤指数指导下的高功率消融可缩短房颤消融时间而不增加并发症。

Objective To evaluate efficiency and safety of atrial fibrillation(AF)ablation using high power short duration(HPSD)guided by lesion size index(LSI).Methods Patients admitted for AF ablation were randomly divided into study group and control group and underwent ablation of HPSD and routine ablation,respectively,both guided by LSI.The target value of LSI was 5.0~6.0 in anterior and roof locations and 4.0~4.5 in posterior and inferior locations.The ablation endpoint was pulmonary veins isolation(PVI)in both sides.Linear ablation,complex fractionated electrograms ablation and substrate modification would be used as well as need.The first-pass PVI rate,the incidence of complications,ablation time and fluoroscopy time,were compared between the two groups.Results 75 patients were enrolled,of them,38 cases were in control group and 37 cases in study group.There was no significant difference of baseline data between the two groups(all P>0.05).All patients were followed up for 6 months.The first-pass PVI rate was 71.1%in control group and 75.7%in study group.Sinus rhythm was maintained in 86.8%and 86.5%in 3 months,and 81.6%and 86.5%in 6months in control group and study group,respectively,after a single ablation procedure.Ablation time was significantly shorter in study group than in control group for both persistent AF and paradox AF(105.5±35.5min vs 88.6±31.7min,and 115.6±40.8min vs 93.3±39.4min,respectively,all P<0.01).Fluoroscopy time and radiation dose were not significantly different between the two groups(all P>0.05).There was no severe complication in both groups(all P>0.05).Conclusion HPSD guided by LSI may reduce ablation time of AF without increasing complications.