下肺静脉解剖位置对冷冻消融60s电隔离成功率的影响

Anatomical position of inferior pulmonary veins on the impact of time to isolation≤60 s in cryoballoon ablation

目的探讨下肺静脉解剖位置对冷冻消融60 s电隔离成功率的影响。方法回顾性分析2022年1月至2022年6月接受冷冻球囊消融治疗的症状性心房颤动患者。术前行CT肺静脉造影检查,测量右下肺静脉(RIPV)及左下肺静脉(LIPV)与左房腹侧成角度数。记录术中RIPV及LIPV总冷冻时间、最低温度、恢复零度时间、肺静脉隔离时间(TTI),RIPV、LIPV组再根据TTI是否≤60 s分为2个亚组(TTI≤60 s,TTI>60 s)。采用受试者工作特征(ROC)曲线分析下肺静脉角度对TTI≤60 s成功率的影响。结果共入选25例。RIPV、LIPV均完成肺静脉隔离,两组总冷冻时间最低温度、恢复零度时间、下肺静脉角度均无差异(P均>0.05)。RIPV及LIPV组组内TTI≤60 s组总冷冻时间、最低温度均小于TTI>60 s组(P均<0.05)。RIPV及LIPV与左房成角度数在TTI≤60 s组明显大于TTI>60 s组[(116.2±8.4)°vs(102.4±8.4)°;(116.7±8.5)°vs(107.1±9.5)°,P均<0.05]。通过ROC分析,RIPV成角度数预测TTI≤60 s的曲线下面积为0.95(P=0.000),LIPV成角度数预测TTI≤60 s的曲线下面积为0.776(P=0.019)。结论通过术前CT肺静脉造影检查可预测冷冻消融的难易程度。

Objective To analysis the anatomical position of inferior pulmonary veins on the impact of TTI(time to isolation)≤60 s in cryoballoon ablation(CBA).Methods Investigated patients with symptomatic atrial fibrillation(AF)who had undergone CBA from January 2022 to June 2022 in our hospital.Computed Tomography(CT)angiography of pulmonary vein were scaned in preoperation.We measured the ventral angle between the vertical line and the direction of each PV trunk(PV angle)on the transverse plane of enhanced CT images.The duration of cryoballoon applications,balloon nadir temperature,interval thaw time at 0℃and TTI of inferior pulmonary veins were recorded.According to the TTI,patients were divided into two groups(TTI≤60 s group,TTI>60 s group).Receiver operating characteristic(ROC)curve were used to assess predictive function of PV angle for predicting the success rate of TTI≤60 s.Results Twenty-five patients were enrolled In TTI≤60 s group,the duration of cyroballoon applications were notably shorter and balloon nadir temperature were more cooler than that in TTI>60 s group(all P<0.05).The PV angle of RIPV and LIPV in TTI≤60 s group were significantly more than that in TTI>60 s group[(116.2±8.4)°vs(102.4±4.4)°;(116.7±8.5)°vs(107.1±9.5)°,all P<0.05].With ROC analysis,The area under curve(AUC)of PV angle of RIPV on prediction for TTI≤60 s was 0.95(P=0.000).The AUC of PV angle of LIPV on prediction for TTI≤60 s was 0.776(P=0.019).Conclusion The difficulty of CBA is better predicted through CT angiography of pulmonary veins in preoperation.