心房颤动冷冻球囊消融术中影响肺静脉电位实时记录的因素分析

Factors affecting real-time recordings of pulmonary venous potentials during second-generation cryoballoon ablation for atrial fibrillation

目的分析心房颤动(房颤)冷冻球囊消融术中影响肺静脉电位(PVP)实时记录的因素。方法回顾性分析2019年6月至2020年12月在泰达国际心血管病医院首次使用2代冷冻球囊消融治疗房颤的病例,所有患者术前均已完善左心房CT血管造影检查,收集其肺静脉内径(长径、短径)、椭圆度、术中Achieve电极位置和形状等信息,根据是否记录到肺静脉电位分为记录组、未记录组,通过统计学方法分析影响肺静脉电位记录的因素。结果共计对102例患者中的408根肺静脉进行了冷冻消融,年龄(64.9±7.3)岁,其中女58例(56.9%,58/102)。记录组共有262根(64%,262/408)肺静脉实时记录到PVP,不同的肺静脉PVP实时记录率差异有统计学意义(χ^(2)=11.477,P=0.009),其中记录率左上肺静脉(LSPV)最高为75%,右上肺静脉(RSPV)63%,左下肺静脉(LIPV)66%,右下肺静脉(RIPV)最低为53%。单因素分析结果显示,Achieve电极位于肺静脉近段、呈环状更容易记录到肺静脉电位(χ^(2)=7.566,P=0.006;χ^(2)=8.706,P=0.003);多元logistic分析结果显示,仅肺静脉分类对于PVP记录率有影响(P=0.044),与RSPV相比,LSPV更易记录到PVP(OR=1.938,95%CI 1.028~3.654,P=0.041)。根据肺静脉类型行亚组分析显示:LSPV、RSPV、RIPV组肺静脉内径(长径、短径)、椭圆度、Achieve电极形态及位置在记录组和未记录组间差异无统计学意义;仅LIPV两组间椭圆度差异有统计学意义(P=0.029)。结论肺静脉电位记录率在不同肺静脉有明显差异,Achieve电极位置和形态对此均有影响。

Objective To analyze the factors that affect the visualization of real-time(RT)recordings of pulmonary vein potential(PVP)during second-generation cryoballoon(2-CB)ablation for atrial fibrillation.Methods Patients who having undergone cryoballoon ablation for atrial fibrillation in TEDA International Cardiovascular Hospital from June 2019 to December 2020 were included in this retrospective observational study.All patients had complete computed tomography scans of the heart before the ablation.Anatomical characteristics including PV max diameter,PV minimum diameter,PV ovality and the shape and position of Achieve electrodes were tested between two groups(PVP group and non-PVP group).Results A total of 102 patients,408 pulmonary veins(PV)were included in the study.The average age was(64.9±7.3)years old,and 58 were female(56.9%,58/102).RT recordings were detected in 262 of 408 PVs(64%,262/408).RT recordings were visualized in 75%of left superior pulmonary vein(LSPV),63%of right superior pulmonary vein(RSPV),66%of left inferior pulmonary vein(LIPV),53%of right inferior pulmonary vein(RIPV)(χ^(2)=11.477,P=0.009).It was easier to record PVP when the Achieve electrode was circular and located in the proximal segment of PV according to univariate analysis(χ^(2)=7.566,P=0.006;χ^(2)=8.706,P=0.003).Multivariate logistic analysis showed that only PV classification had an effect on RT recordings(P=0.044).PVPs were easier to record in LSPV compared with RSPV(OR=1.938,95%CI 1.028~3.654,P=0.041).According to subgroup analysis of PV type,only LIPV ovality had an effect on PVP recording rate(P=0.029).Conclusion The rate of RT recordings was significantly different among different PVs,and was affected by the shape and position of the Achieve electrode.