摘要
目的探讨采用第二代冷冻球囊进行冷冻消融治疗阵发性心房颤动(房颤)的安全性和有效性。方法2016年8月至2017年8月在中国医学科学院阜外医院心律失常中心接受第二代冷冻球囊消融治疗房颤患者112例。记录每支肺静脉冷冻消融相关参数和并发症事件。手术3个月后进行规律的门诊随访,房颤复发定义为随访期内任何时间出现持续时间≥30 s房颤、心房扑动(房扑)或房性心动过速(房速)。结果在平均9(5,16)个月的随访中,冷冻消融治疗的成功率为86.6%(97/112)。术中在452根肺静脉冷冻消融中,平均每根肺静脉冷冻2[1,3]次,平均最低温度-47[-36,-57]℃。双上肺静脉冷冻消融中平均最低温度[左上肺静脉(LSPV)-49℃±5℃;右上肺静脉(RSPV)-50℃±6℃]低于双下肺静脉[左下肺静脉(LIPV)-43℃±5℃,右下肺静脉(RIPV)-45℃±3℃,P〈0.01]。52.9%肺静脉在第1次冷冻消融中实时肺静脉电隔离(PVI),67.0%肺静脉可以监测到实时PVI过程,96.2%肺静脉最终达到PVI。第1次冷冻中实时观察到PVI的过程,LSPV比例高于LIPV(P=0.014)、RSPV(P=0.002 2)和RIPV(P〈0.000 1),LIPV高于RIPV(P=0.002);冷冻消融中实时PVI的比例LSPV高于RSPV(P=0.012 6)和RIPV(P〈0.000 1),LIPV高于RIPV(P〈0.000 1);但最终达到PVI比例在不同肺静脉之间差异无统计学意义。围术期并发症发生率7.1%,其中5例(4.5%)患者发生膈神经损伤,1例(1.0%)发生膈神经麻痹。结论采用第二代冷冻球囊进行冷冻消融治疗阵发性房颤是安全有效的,膈神经损伤仍是其主要并发症之一。
ObjectiveTo investigate the safety and effectiveness of second generation balloon cryoablation for paroxysmal atrial fibrillation.MethodsA total of 112 patients with paroxysmal atrial fibrillation were received cryoablation with the second generation cryoballoon. The cryoablation related parameters of every pulmonary vein (PV) and complications were collected. The regular clinical follow-ups were carried out after 3 months of blank period. The recurrence was defined as atrial fibrillation or atrial flutter or atrial tachycardia which lasting for ≥30 s during follow-up.ResultsThe success rate of cryoablation for paroxysmal atrial fibrillation was 86.6% during mean 9 (5, 16) months follow-up period. In a total of 452 PVs cryoablation, the mean times of cryoablation were 2 (1, 3) , the mean lowest temperature were -47[-36, -57]℃. The mean minimum temperature in the bilateral superior pulmonary veins (LSPV: -49℃±5℃, RSPV: -50℃±6℃) was lower than that in the inferior ones (LIPV: -43℃±5℃, RIPV: -45℃±3℃) , P〈0.01) . 52.9% PV were isolated during the first cryoablation, 96.2% PVs finally reached PVI. The rate of PVI was higher in the LSPV than in RSPV (P=0.012 6) and RIPV (P〈0.000 1) , and higher in the LIPV than in RIPV (P〈0.000 1) during the first cryoballoon ablation. However, the total PVI rates were not different among these pulmonary veins. The perioperative complication rate was 7.1%, of which 5 (4.5%) patients had phrenic nerve injury, and only 1 patient had phrenic nerve palsy.ConclusionCryoablation for paroxysmal atrial fibrillation with second generation cryoballoon is safe and effective. Phrenic nerve injury is still one of the major complications.
作者
李晓枫
刘俊
张浩
夏雨
韦颖
陈会校
方丕华
张澍
Li Xiaofeng;Liu Jun;Zhang Hao;Xia Yu;Wei Ying;Chen Huixiao;Fang Pihua;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)
出处
《中华心律失常学杂志》
2018年第5期419-423,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
心房颤动
冷冻消融
冷冻球囊
Atrial fibrillation
Cryoablation
Cryoballoon