HD-Grid高密度标测导管在阵发性心房颤动消融术后复发患者中的应用

Preliminary experience of HD-Grid in paroxysmal atrial fibrillation patients with recurrent after first ablation

目的应用高密度标测导管HD-Grid(HDG),准确识别肺静脉再连接,降低心房颤动(简称房颤)导管消融后复发率.方法从2020年1月至2021年1月,连续入选30例因阵发性房颤行射频消融手术,术后房颤复发患者,分别使用环肺电极和HDG进行左房电解剖标测,比较两组间识别出肺静脉再连接的差异,并以此指导再次肺静脉隔离,观察远期房颤复发率.结果30例患者年龄(68.00±8.25)岁,男18例,女12例.应用HDG标测,24例发现了72处肺静脉再连接,应用环肺电极,仅在12例患者中发现了24处肺静脉再连接.与环肺电极相比,HDG可以识别出更多的肺静脉再连接位点数[3(2,4)vs 0.8(0.4,1.0),P<0.05].30例在HDG指导下再次肺静脉隔离后,在12个月随访时间内,5例再次出现房颤复发,其中能够识别到肺静脉再连接者,仅1例出现房颤复发.结论HDG能帮助识别出更多的肺静脉再连接,以其指导肺静脉隔离,降低房颤复发的概率.

Objective The application of high-density mapping catheter HD-Grid to accurately identify pulmonary vein reconnection may reduce the recurrence rate of atrial fibrillation after catheter ablation.Methods From January 2020 to January 2021,30 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation with recurrence were consecutively selected.The differences in pulmonary vein reconnection identified between the two groups were compared and used to guide pulmonary vein isolation again,and the long-term recurrence rate of atrial fibrillation was observed.Results The average age of 30 patients was(68.00±8.25)years old,and 18 patients(60%)were male.Using HDG mapping,72 pulmonary vein reconnections were found in 24 patients,and only 12 patients were found using standard bipolar electrodes.Comparedto standard bipolar electrodes,HDG could identify more pulmonary vein reconnections,and the difference was statistically significant:reconnection cases(24 vs 12);reconnecitongap[3(2,4)vs 0.8(0.4,1.0),P0.05].After pulmonary vein isolation was performed again in 30 patients under the guidance of HDG,5 patients had recurrence of atrial fibrillation during the 12-month follow-up period.Among those whose pulmonary vein reconnection could be identified,only 1 patient had recurrence of atrial fibrillation.Conclusions HDG can help identify more pulmonary vein reconnections,which can guide pulmonary vein isolation,and reduce the probability of atrial fibrillation recurrence.[Chinese Journal of Cardiac Pacing and Electrophysiology,2023,37(3):210-214]