应用STSF消融导管隔离肺静脉治疗心房颤动的疗效

Efficacy and safety of pulmonary vein isolation using Thermocool Smart Touch Surround Flow catheter

目的评价采用STSF导管进行肺静脉隔离(PVI)治疗心房颤动(简称房颤)的有效性和安全性。方法本研究纳入48例行PVI的药物难治性阵发性房颤患者。采用STSF消融导管的24例为STSF组,同期使用普通压力导管(CF导管)的24例患者作为CF组。比较两组患者之间的即刻肺静脉-心房电隔离成功率、术后窦性心律维持率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。亚组分析评估两组合并心力衰竭(简称心衰)患者的术中灌注量、术中急性心衰、使用利尿剂情况。结果两组即刻成功率与窦性心律维持率无差异。与CF组比较,STSF组手术及消融时间有明显缩短的趋势,但未达统计学意义。与CF组比较,STSF组X线透视时间明显缩短[(7.8±3.1)min vs (11.2±6.3)min;P=0.02];灌注量更低[356(340,364)ml vs 700(620,772)ml;P=0.00]。两组均未发生并发症。CF组房颤合并心衰的患者10例中有2例术中发生心功能恶化,5例术后需要静脉使用利尿剂缓解症状,而STSF组6例心衰患者仅有1例术后需要静脉使用利尿剂,术中无急性心功能恶化发生。结论应用STSF导管进行PVI治疗安全、有效。术中流体负担显著减少。

Objective To evaluate the efficacy and safety of pulmonary vein isolation(PVI)using Thermocool Smart Touch Surround Flow(STSF)catheter.Methods A total of 48 patients suffering from drug-refractory and paroxysmal atrial fibrillation were enrolled in this study,who underwent circumferential PVI using either the STSF ablation catheter(24 patients,STSF group)or the contact force catheter(24 patients,CF group).PVI acute success rate,postoperative sinus rhythm maintenance,procedure time,X-ray fluoroscopy time,ablation time,irrigation fluid volume and complication were compared between the two groups.To compare irrigation fluid volume,rate of acute heart failure,and diuretic use in patients with heart failure in two groups.Results There was no difference between the PVI acute success rate and sinus rhythm maintenance during follow-up between the two groups.Compared with the CF group,the procedure time and ablation time in the STSF group tend to be shortened.The X-ray fluoroscopy time in the STSF group was significantly shortened than that in CF group[(7.8±3.1)min vs(11.2±6.3)min;P=0.02];The irrigation volume was lower(356(340,364)ml vs 700(620,772)ml;P=0.00)No complications occurred in either group.In the CF group,2 out of 10 patients with heart failure had intraoperative deterioration of heart function,and 5 patients needed intravenous diuretics to relieve symptoms,while only 1 out of 6 patients with heart failure in the STSF group needed intravenous diuretics and no intraoperative deterioration of heart function occurred.Conclusion PVI using the STSF catheter is safe and effective.The upgraded tip irrigation results in a significant reduction in procedural fluid burden.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(4):325-327]