消融指数指导下单导管高功率射频消融在肺静脉隔离中的短期疗效及安全性

Short-term effectiveness and safety of ablation index guided high-power ablation using single ablation catheter in patients with atrial fibrillation

目的探讨消融指数(ablation index,AI)指导下单导管高功率射频消融在肺静脉隔离(pulmonary vein isolation,PVI)中的安全性和有效性。方法回顾性纳入77例行房颤导管射频消融患者,分为单导管高功率消融组(HP组)和常规功率消融组(CP组),2组均以AI为参考。HP组应用单消融导管(SmartTouch Surrounding Flow,STSF)进行标测和消融;CP组应用消融导管(SmartTouch,ST)在环状标测导管指导下进行消融。所有患者AI目标值为前壁450~500,顶部400~450,后壁和底部350~400。消融终点为双侧肺静脉隔离即心房、肺静脉双向传导阻滞。比较2组患者一般基线资料、消融相关参数(每点消融时间、每点阻抗下降率、肺静脉隔离时间、总手术时间、左/右肺静脉单圈隔离率、盐水灌注量)、并发症以及随访6个月成功率。结果与CP组相比,HP组肺静脉隔离时间、总手术时间均缩短(P<0.05),每点消融电阻抗下降率更低(P<0.01),盐水灌注量减少更明显(P<0.01);HP组的左/右肺静脉单圈隔离率更高,但差异无统计学意义(P>0.05)。所有患者完成6个月随访,CP组术中发生1例股静脉穿刺处血肿。2组在维持窦性心律方面成功率差异无统计学意义(P>0.05);在持续性房颤中,HP组成功率高于CP组,但差异无统计学意义(P>0.05)。结论与常规功率环状标测导管指导下的肺静脉隔离相比,AI指导下的单消融导管高功率消融可以提高手术效率,缩短肺静脉隔离时间及总手术时间,是安全有效的。

Objective To investigate the safety and effectiveness of ablation index(AI)guided high-power ablation using single ablation catheter for pulmonary vein isolation(PVI).Methods A total of 77 patients who underwent catheter ablation for atrial fibrillation were selected and their clinical data were retrospectively analyzed.They were divided into two groups:a high-power(HP)ablation using single ablation catheter group and a conventional power(CP)group.Both groups underwent PVI guided by AI.Patients in the CP group received standard protocol(SmartTouch catheter and circular mapping catheter),while those in the HP group used single ablation catheter(SmartTouch Surrounding Flow).Furthermore,the target values of AI were 450-500 for the anterior wall,400-450 for the top wall and 350-400 for the posterior wall and inferior wall.The end point of ablation was the isolation of the bilateral pulmonary vein,that is bidirectional block of the atrium and pulmonary vein.Both groups were compared for basic information,ablation parameters(ablation time per lesion,the rate of impendence drop,PVI time,total surgical time,the single shot isolation rate of the left/right pulmonary vein and saline irrigation volume),complications and the recurrence rate at 6-month follow-up.Results There were no significant differences in the patients′baseline data between the CP group and the HP group(P>0.05).Compared with the CP group,the HP group showed remarkable decreases in PVI time and total surgical time(P<0.05),decreases in the rate of impendence drop(P<0.01),and decreases in saline irrigation volume(P<0.01),while the single shot isolation rate of the left/right pulmonary vein in the HP group increases,without statistical differences(P>0.05).All the patients successfully finished 6-month follow-up,while one case of groin hematoma was observed in the CP group.There was no statistical difference in the success rate of maintaining sinus rhythm between the two groups(P>0.05).For persistent atrial fibrillation,the success rate was higher in the HP group than the CP group,without statistical difference(P>0.05).Conclusions Compared with conventional PVI,AI-guided high power ablation using single ablation catheter is safe and effective,with shortened PVI time and surgical time.