冷冻球囊消融术与射频导管消融术治疗阵发性心房颤动疗效及安全性比较

Comparison of efficacy and safety between cryoballoon ablation and radiofrequency catheter ablation in the treatment of paroxysmal atrial fibrillation

目的探讨冷冻球囊消融术(CBA)与射频导管消融术(RFCA)治疗阵发性心房颤动(PAF)患者的有效性及安全性。方法选取北部战区总医院心血管内科自2019年1月至2020年1月收治的561例接受肺静脉电隔离术(PVI)的PAF患者为研究对象。根据不同的手术方式将其分为RFCA组(n=281)与CBA组(n=280)。分别于出院后第1、3、6、12个月,进行门诊或电话随访。记录并比较两组患者的临床资料、静脉消融相关指标、不同时间心房颤动复发率及再住院率、病死率,以及手术相关并发症发生率。结果两组患者年龄、男性比例、体质量指数、术前左房大小、射血分数、卒中风险评分、出血风险评分等临床资料比较,差异均无统计学意义(P>0.05)。RFCA组、CBA组患者术中肺静脉电隔离率均为100%。CBA组患者消融持续时间明显短于RFCA组,差异有统计学意义(P<0.05)。两组患者透视时间、曝光量比较,差异均无统计学意义(P>0.05)。两组术后3、6、12个月心房颤动复发率比较,差异均无统计学意义(P>0.05)。RFCA组、CBA组患者术后并发症发生率分别为4.3%(12/281)、3.9%(11/280),差异无统计学意义(P>0.05)。结论CBA与RFCA治疗PAF患者疗效及安全性无明显差异,但CBA治疗PAF操作相对简单、手术时间短、患者痛苦少,对于PAF患者,CBA为一种优选的消融策略。

Objective To investigate the efficacy and safety of cryoablation(CBA)and radiofrequency catheter ablation(RFCA)in the treatment of paroxysmal atrial fibrillation(PAF).Methods A total of 561 patients with PAF who underwent pulmonary venous electrical isolation(PVI)were selected from January 2019 to January 2020 in General Hospital of Northern Theater Command.According to different surgical methods,they were divided into RFCA group(n=281)and CBA group(n=280).Outpatient or telephone follow-up was performed at 1,3,6 and 12 months after discharge.Clinical data,venous ablation related indicators,atrial fibrillation recurrence and re-hospitalization rates at different times,mortality rates,and the incidence of surgery-related complications were recorded and compared between the two groups.Results There were no significant differences in age,male proportion,body mass index,preoperative left atrial size,ejection fraction,stroke risk score and bleeding risk score between two groups(P>0.05).The electrical isolation rate of pulmonary vein in RFCA group and CBA group was 100%.The ablation duration of CBA group was significantly shorter than RFCA group,and the difference was statistically significant(P<0.05).There were no significant differences in fluoroscopic time and exposure between two groups(P>0.05).There was no significant difference in the recurrence rate of atrial fibrillation between the two groups at 3,6 and 12 months after surgery(P>0.05).The incidence of postoperative complications in RFCA group and CBA group was 4.3%(12/281)and 3.9%(11/280),respectively,with no statistical significance(P>0.05).Conclusion There was no significant difference in efficacy and safety between CBA and RFCA in the treatment of PAF patients,but CBA was a preferred ablation strategy for PAF patients with relatively simple operation,short operation time and less pain.