新型可视可调弯长鞘在环肺静脉电隔离中的临床应用

Clinical application of a new-type steerable sheath in circumferential pulmonary vein electrical isolation

目的 探讨环肺静脉电隔离过程中应用VIZIGO可视可调弯长鞘的经验。方法 选取2021年7月至2021年12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50例心房颤动(房颤)患者,术中应用VIZIGO鞘(A组)或固定弯形长鞘(B组)各25例。所有患者均接受环肺静脉电隔离术。将肺静脉分为后壁(PST)、下壁(INF)、前壁(ANT)、顶部(RF)及嵴部(RG)等不同分区,比较肺静脉各分区消融时间和消融导管稳定性。结果 两组患者临床基线资料比较差异均无统计学意义(均P<0.05)。所有患者均成功完成环肺静脉电隔离,无并发症发生。与B组相比,A组肺静脉各分区消融时间均有不同程度缩短,其中PST[(5.48±1.24) min比(7.3±1.68) min]、INF[(3.98±0.64) min比(5.18±0.76) min]、RF[(4.48±1.21) min比(6.13±1.32) min]消融时间明显缩短(均P<0.05);导管压力标准差均有不同程度降低,其中PST(3.8±0.78比5.65±1.45)、INF(2.95±1.12比3.83±0.87)、ANT(3.78±0.92比4.45±1.08)导管压力标准差呈明显降低趋势,(均P<0.05)。结论 环肺静脉电隔离过程中使用VIZIGO鞘管操作简便、安全有效,消融导管稳定性更佳。

Objective To discuss the clinical application of VIZIGO sheath, a new-type steerable sheath which can be visualized by a 3D mapping system, in performing circumferential pulmonary vein electrical isolation(CPVEI). Methods A total of 50 patients with atrial fibrillation(AF), who underwent radiofrequency ablation(RFA) at the Affiliated Sixth People’s Hospital of Shanghai Jiao Tong University between July 2021and December 2021, were enrolled in this study. During operation, VIZIGO sheath was used in 25 patients(group A) and conventional fixed-curve sheath was used in other 25 patients(group B). CPVEI was performed in all 50 patients. The pulmonary vein was divided into the following different zones: posterior(PST), inferior(INF), anterior(ANT), roof(RF) and ridge(RG) zones. The ablation time and the ablation catheter stability in each zone of the pulmonary vein were compared. Results There were no statistically significant differences in the clinical baseline data between the two groups. Successful CPVEI was accomplished in all 50 patients and no complications occurred. The ablation time at the different pulmonary vein zones in group A was shorter than those in group B to varying degrees. In group A and group B, PST was(5.48 ±1.24) min and(7.3 ±1.68) min respectively, INF was(3.98 ±0.64) min and(5.18 ±0.76) min respectively, and RF was(4.48±1.21) min and(6.13±1.32) min respectively. The mean standard deviations of the catheter pressure showed varying degrees of reduction in both group A and group B, among which PST was(3.8±0.78) and(5.65±1.45) respectively, INF was(2.95±1.12) and(3.83±0.87) respectively, and ANT was(3.78±0.92) and(4.45±1.08) respectively, the differences in the above indexes between the two groups were statistically significant(all P<0.05). Conclusion In performing CPVEI procedure for patients with AF,VIZIGO sheath is easy-to-operate, safe and effective, and the stability of ablation catheter is better.(J Intervent Radiol, 2022, 31: 857-860)