冷冻消融治疗阵发性心房颤动的疗效及影响因素

The effet and influencing factors of eryoballon ablation for paroxysm atrial fbrilation

目的回顾冷冻消融术(CBA)治疗阵发性心房颤动(简称房颤)的数据,分析其与阵发性房颤远期疗效之间的关系。方法选取复旦大学附属中山医院心内科在2019年1月至2020年9月内完成了阵发性房颤的CBA患者为研究对象,术中逐一记录每支肺静脉形态学及CBA术中的消融数据,并完成术后12个月的随访。结果共入选85例,男性62例(占72.9%),年龄为(59.5±9.8)岁。在术后12个月的随访期内,共有18例患者发生房颤晚期复发,有效率为78.8%(67/85)。根据是否发生房颤晚期复发,将观察对象分为有效组与复发组。结果显示左房大小[(40.88±3.51)mmvs(43.11±4.16)mm]、左下肺静脉(LIPV)冷冻时间[(201.39±47.42)s vs(237.94±83.12)s]、LIPV冷冻次数[(1.22±0.49)次vs(1.56±0.70)次]、30 s冷冻温度[(-27.68±3.86)℃vs(-24.94±4.46)℃]、60 s冷冻温度[(-36.15±3.47)℃vs(-33.74±4.52)℃],两组有差异(P均<0.05)。多因素logistic回归分析房颤患者CBA术后晚期复发的相关危险因素,提示左房大小(OR=1.249,95%CI:1.045~1.492,P=0.014)是房颤CBA术后晚期复发的独立风险因素。85例中,53例肺静脉分支正常,32例存在肺静脉多分支。在术后12个月的随访期内,共有18例患者发生房颤晚期复发,其中肺静脉分支正常的有12例,肺静脉多分支的有6例,复发率无显著差异。结论CBA在阵发性房颤中的治疗是有效的,术后12个月内的复发率与左房大小、LIPV术中数据相关。左房大小是房颤冷冻消融术后晚期复发的独立风险因素。肺静脉形态学异常与房颤晚期复发可能无关。

Objective To discuss the parameter characteristics of cryoballoon ablation(CBA)in the treatment of paroxysmal atrial fibrilation(PAF);①To discuss the relationship between cryoablation parameters and the effect of PAF treatment.Methods The study enrolled PAF patients treated in CBA from January 2019 to September 2020 in the Department of Cardiology of Zhongshan Hospital Affiliated to Fudan University.The parameters of each pulmonary vein were recorded during the cryoablation,and we completed one year follow-up.Result Among the 85 patients,there were 62 males(72.9%).The average age was(59.5±9.8)years.During the follow-up period of 12 months after ablation,18 patients had late recurrence of atrial fibrillation,and the effective rate was 78.8%(67/85)②According to the late recurrence of atrial fibrillation,the patients were divided into non recurrence group and recurrence group.The results showed that the left atrial size[(40.88±3.51)mm vs(43.11±4.16)mm],left inferior pulmonary vein(LIPV)cryoablation time[(201.39±47.42)s vs(237.94±83.12)s],LIPV cryoablation times[(1.22±0.49)vs(1.56±0.70)],the freezing temperature of LIPV at 30 s[(-27.68±3.86)℃vs(-24.94±4.46)℃],and the freezing temperature of LIPV at 60 s[(-36.15±3.47)℃vs(-33.74±4.52)℃],there were differences between the two groups(all P<0.05).③Multi-factor logistic regression analysis showed that left atrial size(OR=1.249,95%CI=1.045-1.492,P=0.014)was an independent risk factor for late recurrence of atrial fibrillation after cryoablation procedure.④Among 85 patients,53 patients had normal pulmonary vein branches and 32 patients had anatomical variated pulmonary vein branches.During the follow-up period of 12 months after procedure,18 patients had late recurrence of atrial fibrillation,including 12 patients with normal pulmonary vein branches and 6 patients in anatomical variated pulmonary vein group.There was no significant difference in the recurrence rate.Conclusion CBA is effective in the treatment of PAF.The recurrence rate of arrhythmia within 12 months after cryoablation is related to the size of left atrium and the parameters of LIPV.Left atrial size is an independent risk factor for late recurrence of atrial fibrllation after cryoablation.Anatomical variation of pulmonary veins is not associated with late recurrence of atrial fibrllation.