心腔内超声在心房颤动导管消融术中的应用

The effect of intracardiac echocardiography technologies on atrial fibrillation ablation

目的 探讨应用心腔内超声(ICE)对心房颤动(简称房颤)导管消融手术的影响。方法 选取云南省第一人民医院2016年3月至2019年10月入院并接受射频消融手术治疗的阵发性和持续性房颤患者共205例,依据术中是否使用ICE导管分为2组,超声组102例(阵发性房颤70例,持续性房颤32例),非超声组103例(阵发性房颤70例,持续性房颤33例),各组再依据房颤类型又分为阵发性房颤与持续性房颤亚组;超声组在ICE指导下行房间隔穿刺,非超声组在X射线下行房间隔穿刺,两组均应用三维电生理标测导航系统(美国强生公司CARTO3系统)分别在ICE导管(美国强生公司soundstar)指导下及PENTARAY导管指导下行心腔的三维建模,在此三维模型上行房颤射频消融术。比较两组的总手术时间、建模时间、房间隔穿刺时间、肺静脉隔离时间、X线曝光时间、X线曝光剂量、并发症及手术成功率等情况。结果 超声组与非超声组患者组间临床基线特性无显著差异。超声组较非超声组的X线曝光剂量明显减小[17.5(11.0,26.3)mGy vs 67.0(43.0,92.0)mGy,P<0.05],X线曝光时间明显缩短[150.0(104.0,204.0)s vs 503.0(354.0,678.0)s,P<0.05];在总手术时间上超声组有所缩短[(192.6±49.7)min vs (208.1±48.0)min,P<0.05];两组手术总并发症发生率无明显差异(超声组3.92%,非超声组4.85%,P=0.746);随访至术后6个月,两组无症状性房性心律失常的发生率相似(75.5%vs 72.8%,P=0.664)。在持续性房颤亚组分析中,与非超声组相比,超声组房间隔穿刺时间、三尖瓣峡部消融时间均减少(P均<0.05)。结论 ICE指导下的房颤导管消融术降低房颤消融术中的X线曝光时间及X线曝光剂量,可缩短手术时间,且不增加并发症。

Objective To investigate the effect of intracardiac echocardiography(ICE) technologies on atrial fibrillation(AF) ablation. Method A total of 205 patients with paroxysmal and persistent atrial fibrillation who were admitted to the hospital from March 2016 to October 2019 in The First People’s Hospital of Yunnan Province, and treated with radiofrequency ablation. According to whether ICE was used or not, they were divided into 2 groups, 102 cases in ultrasound group(70 cases of paroxysmal AF, 32 cases of persistent AF), and 103 cases of non-ultrasound group(70 cases of paroxysmal AF, 33 cases of persistent AF), each group was further divided into paroxysmal AF and persistent AF subgroups according to the type of AF;The ultrasound group underwent transseptal puncture under the guidance of ice and the non-ultrasound group underwent transseptal puncture under the guidance of X-ray. Both groups used Endocardial 3 D Mapping System(Johnson & Johnson CARTO3 system) to conduct 3 d modeling of the cardiac cavity under the guidanced by intracardiac ultrasound catheter(Johnson & Johnson Soundstar) and PENTARAY catheter respectively, and perform AF radiofrequency ablation on this model.The total operation time, modeling time, transseptal puncture time, pulmonary vein isolation time, fluoroscopic time, fluoroscopic dose,complications and surgical success rate were compared between the two groups. Results There were no differences in clinical baseline characteristics between the two groups.Compared with the the non-ultrasound group,the fluoroscopic dose of the ultrasound group was significantly reduced[17.5(11.0,26.3)mGy vs 67.0(43.0,92.0)mGy,P<0.05],and the fluoroscopic time was significantly shortened[150.0(104.0,204.0)s vs 503.0(354.0,678.0)s,P<0.05].The total operation time was shorter in the ultrasound group[(192.6±49.7)min vs(208.1±48.0)min,P<0.05].There was no significant difference in complications between the two groups(3.92%in the ultrasound group vs.4.85%in the non-ultrasound group,P=0.746);in the 6-month follow-up,the incidence of asymptomatic atrial arrhythmias was similar between the two groups(75.5% vs 72.8%,P=0.664).In the subgroup analysis of the persistent AF,the time of transseptal puncture and the time of tricuspid isthmus ablation were reduced in the ultrasound group compared with the non-ultrasound group(all P<0.05). Conclusion Catheter ablation of AF under the guidance of ICE can reduce the fluoroscopic time and fluoroscopic dose in AF ablation,shorten the time of operation,without increasing the incidence of complications.