长程持续性心房颤动不同导管消融术式疗效及安全性比较

Comparison of the efficacy and safety of different catheter ablation for longstanding persistent atrial fibrillation

目的探讨长程持续性心房颤动(简称房颤)不同导管消融术式的疗效对比。方法回顾性分析2019年1月至2020年12月就诊于北部战区总医院并接受导管消融治疗的174例病程大于1年的长程持续性房颤患者,按照手术方式不同分为射频消融组(105例)及冷冻球囊消融组(69例)。比较两组患者基线资料包括:性别、年龄、病程、体重指数、吸烟史、饮酒史、左房内径、右房内径、左室内径、左室射血分数、合并疾病等。比较两组患者手术1年成功率及围手术期并发症发生率。结果射频消融组与冷冻球囊消融组患者基线资料差异无统计学意义(P>0.05)。两组患者手术时间差异无统计学意义[(56.5±16.0)min比(56.9±20.0)min,P=0.890]。冷冻球囊消融组X线曝光量较射频消融组明显增加,差异有统计学意义[(187.9±72.0)mGy比(79.8±34.9)m Gy,P<0.001]。冷冻球囊消融组迷走神经反射发生率较射频消融组高,差异有统计学意义(10.1%比1.9%,P=0.040)。冷冻球囊消融组膈神经损伤发生率较射频消融组高,差异有统计学意义(7.2%比0%,P=0.020)。两组患者手术1年成功率的差异无统计学意义(71.4%比69.6%,P=0.792)。结论长程持续性房颤患者,射频消融与冷冻球囊消融1年成功率差异无统计学意义。

Objective To explore the efficacy of different ablation treatments for longstanding persistent atrial fibrillation(AF)with a duration greater than 1 years.Methods A retrospective analysis of 174 patients with longstanding persistent AF with a course of more than 1 years at the Northern Theater General Hospital between January 2019 and December 2020.According to the surgical methods,105 cases were divided in the radiofrequency ablation group and 69 cases in the cryoablation group.The baseline data of the two groups included:gender,age,duration of disease,body mass index,smoking,alcohol consumption,left atrial diameter,right atrial diameter,left ventricular diameter,left ventricular ejection fraction,combined disease,etc.The 1-year success rate and the perioperative complication rate were compared between the two groups.Results There was no significant difference in baseline data between two of them(P>0.05).There was no significant difference in the ablation time between the two groups[(56.5±16.0)min vs.(56.9±20.0)min,P=0.890].The intraoperative X-ray exposure was significantly increased in the cryoablation group compared with the radiofrequency ablation group and the difference was statistically significant[(187.9±72.0)mGy vs.(79.8±34.9)mGy,P<0.001].The incidence of the vagal reflex was significantly increased in the cryoablation group compared with the radiofrequency ablation group and the difference was statistically significant(10.1%us.1.9%,P=0.040).The incidence of phrenic nerve injury was significantly increased in the cryoablation group compared with the radiofrequency ablation group and the difference was statistically significant(7.2%vs.0%,P=0.020).There was no recurrence rate in the two groups after postoperative annual follow-up,and no statistically significant difference(71.4%vs.69.6%,P=0.792).Conclusion There was no significant difference in annual success rate between radiofrequency ablation and cryoballoon ablation for longstanding persistent atrial fibrillation.