摘要
目的探讨磁导航(MNS)指导下心房颤动(房颤)导管消融的有效性和安全性。方法纳入2012年10月至2021年3月南京医科大学附属无锡人民医院心内科住院的成功实施了MNS指导下导管消融的433例房颤患者(磁导航组),穿刺房间隔后,MNS指导下,盐水灌注MNS消融导管行左心房建模和肺静脉前庭电隔离,隔离后采用“牛眼图”软件确认。同期112例患者作为对照组(手动组)完成传统手动消融。记录并比较两组患者的手术操作时间、X线曝光时间、X线曝光量、手术成功率和手术相关并发症等临床情况。术后12个月内每月随访一次。磁导航组根据入组时间,将最初50例患者作为学习曲线组,后续383例患者按时间分成磁导航1组(190例)和磁导航2组(193例),分析该手术的学习曲线。结果①磁导航组和手动组患者性别、年龄、身高、体重、左心房内径和左心室射血分数等基线情况差异无统计学意义。与手工组相比,磁导航组肺静脉前庭隔离急性成功率略低(98.8%对98.2%,P>0.05),手术操作时间略长[(152.7±27.8)min对(149.7±27.3)min,P>0.05],X线曝光时间明显短[(8.4±4.3)min对(16.8±10.9)min,P<0.05]。②学习曲线组、磁导航1组与磁导航2组间年龄、性别和体重等基线情况差异无统计学意义(P>0.05)。与学习曲线组比较,磁导航1组与磁导航2组X线曝光时间显著减少[(13.2±7.2)min对(8.0±3.5)min、(7.6±3.3)min,P<0.05];而磁导航1组与2组间差异无统计学意义(P>0.05)。③围术期磁导航组有2例血胸(锁骨下静脉穿刺所致)和3例腹股沟血肿,无其他手术相关并发症。手工组出现1例心脏压塞、1例肺静脉狭窄、1例脑梗死和3例腹股沟血肿。④磁导航组阵发性房颤与非阵发性房颤1年消融成功率均略高于手工组(71.0%对68.9%,P>0.05;57.2%对55.3%,P>0.05)差异均无统计学意义。结论与手动消融相比,MNS指导下的房颤导管消融术中X线曝光时间和手术并发�
Objective To evaluate the efficacy and safety of atrial fibrillation(AF)ablation guided by magnetic navigation system(MNS).Methods Catheter ablation of AF was successfully performed in 433 patients guided by MNS(MNS group)in the Department of Cardiology of Wuxi People's Hospital Affiliated to Nanjing Medical University from October 2012 to March 2021.Left atrial model and both pulmonary vein isolation were performed with irrigated catheter and confirmed by bull-eye software after transseptal puncture in MNS group.Routine manual ablation was performed in 112 patients as the control group(MA group).Clinical parameters such as procedure time,X-ray exposure time,ablation success rate and procedure-related complications were recorded and analyzed.The first 50 patients were selected as the learning curve group in MNS group,and the subsequent 383 patients were divided into group MNS1(190 cases)and group MNS2(193 cases).And the relevant parameters about the learning curve of the MNS were analyzed.The follow-up was done once a month within 12 months postoperatively.Results There was no significant difference in gender,age,height,weight,left atrial diameter and left ventricular ejection fraction between the MNS group and the MA group(P>0.05).The acute success rate of pulmonary vein antrum isolation in MNS group was slightly lower than that in MA group(98.8%vs.98.2%,P>0.05).The procedure durations in two groups were(152.7±27.8)min and(149.7±27.3)min(P>0.05).However,The X-ray exposure time of MNS group was significantly shorter than that of MA group[(8.4±4.3)min vs.(16.8±10.9)min,P<0.05].There was no significant difference in baseline conditions such as age,sex and weight among the three groups(P>0.05).Compared with the learning curve group,the X-ray exposure time of MNS1 group and MNS2 group decreased significantly[(13.2±7.2)min vs.(8.0±3.5)min,(7.6±3.3)min,P<0.05],There was no significant difference in X-ray exposure time between MNS1 group and MNS2 group(P>0.05).There were 2 cases of hemothorax(caused by subclavian
作者
李库林
郑杰
刘晓宇
郁志明
张常莹
赵晓溪
李晓燕
李嘉萍
王如兴
Li Kulin;Zheng Jie;Liu Xiaoyu;Yu Zhiming;Zhang Changying;Zhao Xiaoxi;Li Xiaoyan;Li Jiaoping;Wang Ruxing(Department of Cardiology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)
出处
《中华心脏与心律电子杂志》
2022年第1期12-17,共6页
Chinese Journal of Heart and Heart Rhythm(Electronic Edition)
基金
国家自然科学基金(81770331)
无锡市双百后备拔尖人才(HBBJ-11)。
关键词
心房颤动
磁导航
导管消融
有效性
安全性
Atrial fibrillation
Magnetic navigation system
Catheter ablation
Efficacy
Safety
