经单侧右股静脉射频消融治疗心房颤动可行性研究

Radiofrequency ablation purely-via right femoral vein approach for the treatment of atrial fibrillation:study of its feasibility

目的探讨经单侧股静脉路径行心房颤动(房颤)射频消融的可行性。方法前瞻性入选2019年1月至2021年3月在上海交通大学附属第六人民医院接受射频消融治疗的房颤患者212例。根据不同的股静脉入路,将患者分为两组,A组(n=116)经传统双侧股静脉路径穿刺置鞘,左侧放置冠状静脉窦电极,右侧放置标测和消融导管,B组(n=96)经改良路径穿刺置鞘,即经单侧右股静脉分别放置冠状静脉窦电极、标测和消融导管。观察对比两组患者股静脉穿刺时间、放置冠状静脉窦电极所需时间、X线总曝光时间和消融时间。结果两组患者临床基线资料差异无统计学意义(P>0.05)。A组、B组穿刺股静脉成功所需时间分别为(446.56±89.25) s、(439.57±67.79) s(P=0.52),放置冠状静脉窦电极所需时间分别为(2.21±1.23) min、(2.05±1.13) min(P=0.33),消融时间分别为(71.34±15.48) min、(69.76±18.03) min(P=0.49),X线曝光时间分别为(3.34±1.87) min、(3.19±1.19) min(P=0.50),差异均无统计学意义。两组患者发生穿刺处假性动脉瘤各1例,B组出现穿刺处血肿1例;均未发生股动静脉瘘、心脏压塞、左心房食管瘘、肺静脉狭窄等并发症。结论经单侧右股静脉路径行房颤射频消融安全可行。

Objective To discuss the feasibility of radiofrequency ablation(RFA) purely-via right femoral vein approach for the treatment of atrial fibrillation(AF). Methods A total of 212 patients with AF,who underwent RFA at the Affiliated Sixth People’s Hospital of Shanghai Jiao Tong University of China between January 2019 and December 2020, were prospectively enrolled in this study. According to the femoral vein approach method, the patients were divided into group A(n=116) and group B(n=96). Conventional bilateral femoral vein puncture with sheath insertion, coronary venous sinus(CS) electrode placement from left side, and the mapping catheter and the ablation catheter placement from right side were employed for the patients of group A, while pure right femoral vein puncture with sheath insertion, CS electrode placement, and the mapping catheter and the ablation catheter placement were adopted for the patients of group B. The time spent for femoral vein puncturing, the time spent for the placement of CS electrode and the mapping catheter, the total X-ray exposure time and the RFA time were compared between the two groups. Results There were no statistically significant differences in the clinical baseline data between the two groups(P>0.05). In group A and group B, the time spent for the femoral vein puncturing was(446.56±89.25) second and(439.57±67.79)second respectively(P=0.52), the time spent for the placement of CS electrode was(2.21 ±1.23) min and(2.05±1.13) min respectively(P=0.33), the RFA time was(71.34±15.48) min and(69.76±18.03) min respectively(P=0.49), and the total X-ray exposure time was(3.34±1.87) min and(3.19±1.19) min respectively(P=0.50).The differences in all the above items between the two groups were not statistically significant. One patient in each group developed pseudoaneurysm at the puncture site, and one patient in group B developed hematoma at the puncture site. No complications such as femoral arteriovenous fistula, cardiac tamponade, left atriumesophageal fistula or pulmonary venous stenosis occurred. Conclusion Purely-via right femoral vein approach to perform RFA for AF is clinically safe and feasible.(J Intervent Radiol, 2021, 30: 985-988)