损伤指数精准指导下高功率消融在肺静脉隔离中的应用研究

Efficiency and safety of pulmonary vein isolation with high power ablation guided by lesion size index

目的评估在损伤指数(LSI)指导下心房颤动(房颤)高功率(HP)消融的有效性及安全性。方法连续入选2018年10月至2019年9月在浙江绿城心血管病医院心内科行房颤(包括阵发性房颤和持续性房颤)导管射频消融患者77例,分为HP组和常规功率(CP)组,两组均以LSI为参考。HP组采用40~50 W功率消融,CP组采用30 W功率消融。所有患者LSI目标值为前壁和顶部5.0~6.0,后壁和底部4.0~4.5。消融终点为双侧肺静脉隔离,比较两组肺静脉隔离时间,LSI及贴靠压力、阻抗,并发症发生率,X线曝光时间及剂量等差异。结果共有CP组40例,HP组37例患者入选,两组基线资料差异无统计学意义。①肺静脉隔离成功率均为100%,单次消融6个月维持窦性心律者HP组和CP组分别为30例(30/37,81.1%)和31例(31/40,77.5%),差异无统计学意义(P>0.05)。②双侧肺静脉隔离消融时间:HP组消融时间显著低于CP组[(23.7±10.4)min对(33.8±11.2)min,P=0.001]。③HP组贴靠压力<10 g的消融点占比显著低于CP组(40.6%对25.1%,P<0.001),HP组阻抗下降值在11~15Ω(25.3%对19.1%,P<0.01)及15~18Ω(22.9%对19.1%,P=0.01)较CP组高。④HP组与CP组X线曝光时间和曝光量差异无统计学意义[(9.2±10.8)min对(13.3±11.4)min,P>0.05;(51.1±78.4)mGy对(67.6±84.8)mGy,P>0.05]。⑤并发症:两组均无严重并发症,普通并发症差异无统计学意义。结论与传统低功率消融相比,以LSI为指导的房颤HP消融的成功率和安全性差异无统计学意义,但明显缩短房颤消融时间,降低左心房后壁贴靠压力。

Objective To evaluate efficiency and safety of pulmonary vein isolation(PVI)using high power(HP)short duration ablation.Methods A total of 77 consecutive patients were enrolled in the study from October 2018 to September 2019 in Zhejiang Greentown Cardiovascular Hospital for radiofrequency catheter ablation of atrial fibrillation(AF).Consecutive patients referred for AF catheter ablation were divided into control conventional-power(CP)group and HP ablation group including paroxysmal atrial fibrillation(PAF)and persistent atrial fibrillation(PsAF).Contact force(CF)sensing catheters were used.Lesion size index(LSI)was used to guide radiofrequency lesion formation.PVI sin the HP group were achieved with HP ablation method,and in the control group PVI were conducted with conventional-power.The power settings in HP group were 50 W in anterior wall and 40 W in posterior wall,respectively.The power setting of PVI in control group was 30 W.An LSI value of 5.0-6.0 in anterior walls and 4.0-4.5 in posterior walls were used as ablation targets.The ablation strategy was PV ant rum isolation in PsAF,PVI plus necessary linear ablation and complex fractionated electro grams ablation in PsAF.We also evaluated the procedural success rate,complication rate,ablation time,fluoroscopic time.Results Seventy-seven patients were enrolled.No significant differences between the two groups in age,left atrial size and ejection fraction were observed.①During 6-month follow-up,30(81.8%,30/37)in CP and 31(77.5%,31/40)in HP(P>0.05)maintained sinus rhythm.②Compared to CP group,the ablation time in Hp group was significantly shortened[(23.7±10.4)min vs.(33.8±11.2)min,P<0.001].③HP group had low percentage of ablation points with CF<10 g than that in CP group(40.6%vs.25.1%,P<0.001).④Fluoroscopic time and radiation dose were similar between HP and CP group[(9.2±10.8)min vs.(13.3±11.4)min,P>0.05;(51.1±78.4)mGy vs.(67.6±84.8)mGy,P>0.05],respectively.⑤There were no severe complications in both group.Conclusion LSI guided HP ablation could reduce procedure time and CF of left atrial posterior wall,without increasing complications.