基于消融指数的射频消融术对心房颤动患者血小板活化、心脏自主神经功能的影响

Effects of Radiofrequency Ablation Based on Ablation Index on Platelet Activation and Cardiac Autonomic Nervous Function in Patients with Atrial Fibrillation

目的探讨基于消融指数(AI)的射频消融(RFA)术对心房颤动(AF)患者血小板活化、心脏自主神经功能的影响。方法选取2020年1月至2022年5月南阳市中心医院80例AF患者,根据治疗方案分组,各40例。对照组基于接触压力参数行RFA术,观察组基于消融指数行RFA术。两组手术相关指标、AF复发率、手术前后血小板活化指标[血小板α颗粒膜蛋白(GMP-140)及血小板膜CD62P、CD63]、24 h内窦性RR间期总体标准差(SDNN)、左心房前后径(LAD)、24 h内5 min RR间期平均值的标准差(SDANN)、左心房容积(LAV)、左心室射血分数(LVEF)、相邻RR间期差值的均方根(RMSSD)及高频/低频(HF/LE)。结果观察组PVI单圈隔离率高于对照组,X线透视、消融及手术总时间短于对照组(P<0.05),两组电复律使用率差异无统计学意义(P>0.05)。术后1~3 d,两组GMP-140、CD62P、CD63先升高后下降,且观察组低于对照组(P<0.05);两组术后即刻、术后1个月LAD、LAV、HF/LE较术前下降(P<0.05),SDNN、SDANN、LVEF、RMSSD水平较术前升高(P<0.05),组间差异无统计学意义(P>0.05)。观察组AF复发率低于对照组(P<0.05)。结论基于AI行RFA术治疗AF患者,有效缩短了消融及手术总时间,提高PVI单圈隔离率,抑制血小板活化,降低复发风险,促进左心房结构及心脏自主神经功能恢复,且不会提高电复律使用率,有益于术者安全、高效地完成手术。

Objective To investigate the effects of radiofrequency ablation(RFA)based on ablation index(AI)on platelet activation and cardiac autonomic nervous function in patients with atrial fibrillation(AF).Methods A total of 80 patients with AF in Nanyang Central Hospital from January 2020 to May 2022 were selected and divided into 40 cases each according to the treatment plan.The control group underwent RFA based on contact pressure parameters,and the observation group underwent RFA based on ablation index.Surgical indicators,AF recurrence rate,platelet activation indicators before and after surgery[plateletαgranular membrane protein(GMP-140)and platelet membrane CD62P,CD63],standard deviation of all normal RR intervals within 24 h(SDNN),anterior and posterior diameter of left atrium(LAD),standard deviation of all 5-minute R-R intervals within 24 h(SDANN),left atrial volume(LAV),left ventricular ejection fraction(LVEF),root mean square of differences between adjacent NN intervals(RMSSD)and high frequency power/low frequency power(HF/LE).Results The isolation rate of PVI in the observation group was higher than that in the control group,and the total time of X-ray fluoroscopy,ablation and operation were shorter than those in the control group(P<0.05).There was no statistical difference in the utilization rate of electric cardioversion between the two groups(P>0.05).From 1 to 3 days after operation,GMP-140,CD62P and CD63 in two groups were increased and then decreased,and the observation group was lower than the control group(P<0.05).LAD,LAV and HF/LE in both groups immediately after surgery and one month after surgery were decreased compared with those before surgery(P<0.05),while SDNN,SDANN,LVEF and RMSSD levels were increased compared with those before surgery(P<0.05),with no statistical difference between groups(P>0.05).The recurrence rate of AF in observation group was lower than that in control group(P<0.05).Conclusion The AI-based RFA in the treatment of AF patients can effectively shorten the total time of ablation and surgery,improve the isolation rate of PVI in one circle,inhibit platelet activation,reduce the risk of recurrence,promote the recovery of left atrial structure and cardiac autonomic nervous function,and does not increase the utilization rate of electrocardioversion,which is conducive to the safe and efficient completion of surgery.