量化消融指导下经验性上腔静脉电隔离治疗阵发性心房颤动的疗效观察

Empirical superior vena cava isolation guided by quantitative ablation improves the efficacy of radiofrequency ablation for paroxysmal atrial fibrillation

目的探索阵发性心房颤动(简称房颤)患者在肺静脉电隔离(PVI)基础上采用量化消融指导下经验性进行上腔静脉电隔离(SVCI)能否提高射频消融治疗成功率。方法回顾性分析2021年10月至2022年9月期间在阜外医院接受单一术者射频消融治疗的症状性阵发性房颤患者。根据术中消融策略分为单纯PVI组和SVCI组(即PVI基础上进行SVCI)。两组患者均在量化消融指导下完成PVI和/或SVCI。术后进行规律临床随访筛查房颤发作。房颤复发定义为任何房颤或心房扑动或房性心动过速发作持续时间大于30 s。结果共156例患者入选,其中PVI组76例,SVCI组81例。与PVI组比较,SVCI组患者合并冠心病(31.2%vs 15.8%,P=0.02)和卒中(18.8%vs 2.6%,P<0.01)比例较高,左房内径较小[(37±4)mm vs(39±5)mm,P=0.02]。术后随访(9±3)个月,SVCI组消融治疗成功率高于PVI组(91.3%vs 79.0%,P=0.03)。多因素Logistic回归分析显示SVCI能够独立预测消融术后房颤复发(RR值1.02,P=0.03)。两组患者并发症发生率无差异。结论在PVI的基础上进行经验性SVCI能够提高阵发性房颤射频消融治疗成功率,并不增加并发症风险。

Objective To explore whether empirical superior vena cava isolation(SVCI)guided by quantitative ablation can improve the success rate of radiofrequency ablation in patients with paroxysmal atrial fibrillation(PAF)based on pulmonary vein isolation(PVI).Methods A retrospective analysis of patients with symptomatic PAF treated with single-operator radiofrequency ablation at Fuwai Hospital between October 2021 and September 2022.According to the strategy during the operation,the patients were divided into the PVI group(single PVI)and the SVCI group(PVI with additional SVCI).PVI and/or SVCI were completed under the quantitative ablation strategy in both groups.Regular clinical follow-up was performed to evaluate the results of radiofrequency ablation therapy and PAF recurrence defined as an episode of AF lasting for≥30 seconds,with or without atrial flutter or atrial tachycardia.Results Among the 156 patients with PAF enrolled,76 patients were in the PVI group and 81 patients were in the SVCI group.The patients in the SVCI group had a higher percentage of history with coronary artery disease(31.2%vs 15.8%,P=0.02)and stroke(18.8%vs 2.6%,P<0.01)and a smaller left atrial diameter[(37±4)mm vs(39±5)mm,P=0.02].With a mean follow-up of(9±3)months after the operation,the success rate of maintaining sinus rhythm was higher in the SVC group than that in the PVI group(91.3%vs 79.0%,P=0.03).The multivariate Logistic regression analysis showed that SVCI could independently predict the recurrence of PAF(RR 1.02,P=0.03).There was no difference in the complication rate between the two groups.Conclusion Empirical SVCI after PVI in patients with PAF can improve the success rate of radiofrequency ablation treatment without increased risk of complication.