房颤患者环肺静脉前庭射频消融路径的分析

Analysis of circumferential pulmonary vein antrum ablation approach for atrial fibrillation

摘要:

目的 比较房颤患者中3种不同环肺静脉前庭射频消融路径的消融成功率。方法 回顾性分析解放军总医院心血管内科2015年6月至2017年6月住院房颤患者173例,根据射频消融线所在区域分为心房前庭组61例、肺静脉前庭组47例和前庭组65例,比较3组患者手术时间、X线曝光时间和消融时间,以及穿刺房间隔后、术后即刻和术后24h血浆中C反应蛋白(CRP)、氨基末端B型脑钠肽前体(NT-proBNP)和白细胞介素-6(IL-6)水平。应用SPSS 17.0统计软件对数据进行分析。组间比较采用单因素方差分析、秩和检验或χ²检验。结果 所有患者在消融过程中达到完全电隔离的即刻成功率为84.39%(146/173)。心房前庭组患者消融时间明显长于肺静脉前庭组患者[(120.67±13.12) vs(90.17±6.95)min],差异有统计学意义(P＜0.05)。相比穿刺房间隔后,3组患者术后即刻和术后24h IL-6水平升高,肺静脉前庭组患者术后24h NT-proBNP水平升高；肺静脉前庭组患者术后24h CRP水平相比心房前庭组患者[(1.99±1.09) vs(0.40±0.29)mg/L]升高,差异均具有统计学意义(P＜0.05)。161例随访12个月,12例失访,失访率为6.94%(12/173)。27例房颤复发,手术成功率为83.23%(134/161),其中心房前庭组手术成功率[89.83%(53/59) vs 73.33%(33/45)]高于肺静脉前庭组,差异具有统计学意义(P＜0.05)。结论 房颤患者不同环肺静脉前庭射频消融路径中,心房前庭侧消融路径优于肺静脉前庭消融路径。

Abstract:

Objective To compare the success rate of 3 different approaches in circumferential pulmonary vein antrum ablation for atrial fibrillation. Methods A retrospective study was carried out on 173 patients with atrial fibrillation admitted in the Cardiology Department of Chinese PLA General Hospital from June 2015 to June 2017. According to the area of radiofrequency ablation line, they were divided into atrial antrum group (n=61), pulmonary vein antrum group (n=47) and antrum group (n=65). The operation time, X-ray exposure time and ablation time, and the plasma levels of C-reactive protein (CRP), N-terminal pro B-type brain natriuretic peptide (NT-proBNP) and interleukin-6 (IL-6) just after atrial septal puncture, immediately and 24h after operation were compared in the 3 groups. SPSS statistics 17.0 was used to analyze the data. Single factor variance analysis, rank sum test or Chi-square test was employed to analyze the intergroup comparison. Results The immediate success rate of complete electrical isolation was 84.39%(146/173) in all patients. The ablation time was significantly longer in the atrial antrum group than pulmonary vein antrum group [(120.67±13.12) vs (90.17±6.95)min, P<0.05]. Compared with the levels after atrial septal puncture, the IL-6 level immediately and 24h after operation were increased in all the 3 groups; the 24h NT-proBNP level was elevated in the pulmonary vein antrum group; and the 24h CRP level was higher in the pulmonary vein antrum group than the atrial antrum group [(1.99±1.09) vs (0.40±0.29)mg/L, all P<0.05]. Among them, 161 patients were followed up for 12 months, and 12 patients were lost during follow-up, with a rate of 6.94%(12/173). Recurrence of atrial fibrillation was observed in 27 cases. The success rate of operation was 83.23%(134/161), with the rate significantly higher in the atrial antrum group than in the pulmonary vein antrum group [89.83%(53/59) vs 73.33%(33/45), P<0.05]. Conclusion The approach of atrial antrum is superior to that of pulmonary vein antrum in circumferential pulmonary vein antrum ablation for atrial fibrillation.