不同术式对于冷冻球囊导管消融治疗心房颤动临床疗效观察

Clinical effect of different procedures for cryoballoon catheter ablation on treatment of atrial fibrillation

目的评估采取不同术式对于冷冻球囊导管消融(CBA)治疗心房颤动(房颤)的临床疗效。方法连续入选2020年5月至2021年6月在辽宁省人民医院心血管病治疗中心接受CBA治疗并完成随访的房颤患者96例,根据不同肺静脉解剖、房颤类型、不同触发灶等特点采取不同术式:分段隔离、扩大前庭消融、左心耳隔离、上腔静脉隔离及顶壁线消融。主要研究终点为1年的成功率;同时观察分析肺静脉隔离(PVI)成功率,手术时间及并发症等相关参数。结果入选房颤患者96例并完成1年随访。其中阵发性房颤62例(64.6%),持续性房颤34例(35.4%),女性36例(37.5%),平均年龄(65.4±16.7)岁。急性PVI成功率99.0%,平均手术时间(72±24)min,平均X线曝光时间(13±7)min,曝光量(153±86)mGy。术中3例患者出现膈神经损伤,2例在10 min后恢复,1例在6个月后恢复。未发生严重外周血管并发症、心脏压塞、左心房食道瘘、支气管损伤及死亡。96例完成1年随访,阵发性房颤成功率为92.1%,持续性房颤成功率80%,总手术成功率87.9%。结论根据不同肺静脉解剖、房颤类型、不同触发灶等特点采取不同冷冻消融术式可提高冷冻消融治疗房颤的手术成功率。

Objective To evaluate the clinical effects of different procedures for cryoballoon ablation(CBA)on the treatment of atrial fibrillation(AF).Methods Ninety-six patients with atrial fibrillation who received CBA treatment and completed follow-up in the Department of Cardiology of The People’s Hospital of Liaoning Province from May 2020 to June 2021 were continuously selected.Different surgical procedures were adopted according to the characteristics of different pulmonary vein anatomy,atrial fibrillation types and different triggering lesions,including segmental isolation,expanded vestibular ablation,left atrial appendage isolation,superior vena cava isolation and parietal line ablation.The main endpoint of the study was the success rate at 6 months and 1 year after surgery.The success rate of pulmonary vein isolation(PVI),operation time,complications and other related parameters were recorded and analyzed.Results All the patients underwent the operation and completed 1 year follow-up.Among them,62 cases(64.6%)were paroxysmal atrial fibrillation and 34 cases(35.4%)were persistent atrial fibrillation,with 36 females(37.5%)and the average age(65.4±16.7)years.The success rate of acute PVI was 99.0%;the average operation time was(72±24)min;the average X-ray exposure time was(13±7)min;and the exposure was(153±86)mGy.During the procedure,3 patients had phrenic nerve injury,of which 2 patients recovered after 10 minutes and 1 patient recovered within 6 months.No serious peripheral vascular complications,cardiac tamponade,left atrial esophageal fistula,bronchial injury and pulmonary vein stenosis occurred.The success rate of paroxysmal atrial fibrillation was 92.14%;the success rate of persistent atrial fibrillation was 80%and the total surgical success rate was 87.9%.Conclusion According to the characteristics of different pulmonary vein anatomy,atrial fibrillation types and different triggering lesions,the use of different cryoablation procedures can improve the success rate of atrial fibrillation treated by cryoballoon ablation.