温控自动监测和阻抗上限监测消融老年人Ⅰ型心房扑动效果比较

Comparative efficacy of temperature-controlled and impedance-limited energy delivery in the ablation of type-Ⅰatrial flutter in the elderly

目的 比较采用温控和阻抗监测消融法电隔离右心房后峡部治疗老年人Ⅰ型房扑的效率和优缺点。方法 在透视解剖标志的指引下 ,在Halo电极三尖瓣环标测电图监测下 ,在房扑发作或冠状窦口起搏时 ,随机选择温控监测和阻抗监测射频消融法电隔离位于三尖瓣口和下腔静脉口之间的后峡部 ,消融方向从右心室到下腔静脉。采用温控监测消融时 ,预设温度 70℃ ;采用阻抗监测消融时 ,能量选择 2 0W ,预设阻抗 15 0 。消融方法都是每点放电 30s,每次移动消融电极 5mm。消融终点是后峡部完全阻滞。比较下列指标 :(1)放电次数 ;(2 )放电时间 ;(3)消融操作时间 ;(4 )消融能量 ;(5 )高阻抗报警次数 ;(6 )病人胸痛反应。结果 37例老年Ⅰ型房扑病人平均年龄 (6 9.2± 3.7)岁 ,男 /女为 2 6 / 11,合并高血压病 13例 ,糖尿病 5例 ,冠心病 3例 ,卵圆孔未闭 1例。房扑心室率(12 8.4± 2 7.5 )次 /min ,呈逆钟向折返 2 5例 ,顺钟向折返 12例。温控监测消融 19例 ,非温控监测消融 18例 ,两组病人在性别、年龄、基础心脏病、房扑心室率和折返方式方面无显著差异 (P >0 .0 5 )。 37例病人全部达到后峡部完全阻滞的消融终点 ,无并发症。温控监测和阻抗监测消融观察指标比较 :(1)放电次数为 6 .4± 3.5比 11.3± 5 .8(P <0 .0 5 )。

Objective To compare the efficacy of temperature-controlled (TC) and impedance-limited (IL) ablation in the treatment of type-Ⅰ atrial flutter (AF) in the elderly. Methods During AF or coronary sinus ostium pacing, TC or IL ablation was randomly used to isolate the posterior isthmus between the the tricuspid ring and inferior vena cava. The target temperature of TC group was 70°C with automatic energy modulation. The impedance upper margin of IL group was 150  with pre-set 20 W energy. Procedure endpoint was complete block of posterior isthmus. Seven parameters were compared between two groups. Results Thirty-seven AF patients were randomized into TC (19 cases) and IL groups (18 cases). There were no differences between two groups in gender, age, basic heart disease, AF rate and reentrant type (P>0.05). All patients were treated successfully without complications. Seven parameters were compared between TC group vs IL group: (1)energy delivery frequency 6.4±3.5 vs 11.3±5.8(P<0.05), (2)energy delivery time 572.8±96.5 vs 914.7±97.6 sec(P<0.05),(3)procedure time 45.2±11.4 vs 56.6±18.3 min (P<0.05),(4)fluoroscopy time 13.5±6.3 vs 21.4±7.6 sec(P<0.05),(5)energy for ablation 14.3±6.5W vs 19.1±3.2W (P<0.05),(6)high impedance alarm frequency 0 vs 5.8±3.6(P<0.05), (7)chest pain rate 10.5% vs 55.6%(P<0.05).Conclusion In the electric isolation of posterior isthmus of aging AF patient, TC ablation is superior to IL ablation in following aspects: (1)less energy delivery number, shorter time and lower energy, (2)shorter fluoroscopy and procedure time, (3)less high impedance alarm frequency, and (4)better patient's tolerance.