心腔内超声心动图下经导管房颤射频消融术有效性及安全性的回顾性队列研究

Efficacy and safety of intracardiac echocardiography-guided radiofrequency ablation for atrial fibrillation:a retrospective report of 192 cases

目的探索心腔内超声心动图(intracardiac echocardiography,ICE)指导下经导管房颤射频消融术的有效性及安全性。方法采用回顾性队列研究设计,收集2019年2月至2021年7月在我科行经导管房颤射频消融术的患者,根据其是否使用ICE,将其分为ICE组(n=192)和非ICE组(n=167),对比2组的放射暴露时间、放射暴露量、消融总时间、单圈隔离率及并发症等,评估ICE指导下房颤导管消融术的有效性及安全性。结果ICE组与非ICE组相比,消融总时间明显缩短[(68.35±1.09)min vs(74.37±1.69)min,P<0.01],单圈隔离率明显提高(70.83%vs 53.89%,P<0.01),放射暴露量[(33.86±1.51)mGy vs(212.30±21.11)mGy,P<0.01]及放射暴露时间[(4.90±0.23)min vs(13.51±0.34)min,P<0.01]明显减少。2组各发生2例并发症,无统计学差异,ICE组无严重并发症,非ICE组术中并发急性心包压塞1例。ICE组消融早期及晚期复发率较非ICE组无显著差异,但晚期复发率有降低的趋势(3.13%vs 7.78%,P=0.06),2组安全性无显著差异。结论ICE指导下经导管房颤射频消融术有更高的消融效率、更少的射线暴露;2组安全性无显著差异,ICE组晚期复发率有降低的趋势。

Objective To investigate the efficacy and safety of catheter ablation for atrial fibrillation under the guidance of intracardiac echocardiography(ICE).Methods A retrospective cohort trial was conducted on all the patients who underwent radiofrequency catheter ablation due to atrial fibrillation in our department from February 2019 to July 2020.They were divided into ICE group(n=192)and non-ICE group(n=167).The radiation exposure time,radiation exposure amount,total ablation time,single coil isolation rate,and incidence of complications were compared between the 2 groups to evaluate the efficacy and safety of ICE-guided ablation for atrial fibrillation.Results The ICE group had significantly shorter total ablation time(68.35±1.09 vs 74.37±1.69 min,P0.01),higher single coil isolation rate(70.83%vs 53.89%,P0.01),less radiation exposure amount(33.86±1.51 vs 212.30±21.11 mGy,P0.01)and shorter radiation time(4.90±0.23 vs 13.51±0.34 min,P0.01)when compared with the non-ICE group.No statistical difference was seen in the incidence of complications between the 2 groups.Complications were observed in 2 cases of both groups.There were no serious complication in the ICE group,while 1 case of intraoperative cardiac perforation was in non-ICE group.Though no significant difference was found in the early and late recurrence rates of ablation in the ICE group than the non-ICE group,a decreasing trend in late recurrence rates was observed in both groups(3.13%vs 7.78%,P=0.06).Conclusion ICE-guided catheter ablation of atrial fibrillation has higher ablation efficiency and less radiation exposure.There is no significant difference in safety between the 2 groups,but ICE leads to a decreasing trend in late recurrence rate.