两种心脏导管射频消融术式治疗阵发性心房颤动的疗效比较

发布时间：2018-06-14 21:01

本文选题：阵发性房颤 + 心脏导管射频消融　；参考：《山东医药》2017年30期

【摘要】：目的比较两种不同心脏导管射频消融术(RFCA)术式即环肺静脉隔离(CPVI)与环肺静脉隔离联合左心房顶部线性消融(CPVI+LARA)治疗阵发性心房颤动(简称房颤)的临床疗效。方法选择因药物治疗无效或无法耐受抗心律失常药物而接受RFCA治疗的阵发性房颤患者174例,根据消融术式不同分为CPVI组84例、CPVI+LARA组90例。CPVI组行CPVI,以肺静脉完全隔离为消融终点。CPVI+LARA组行CPVI达到肺静脉完全隔离后,继续行LARA消融左心房顶部线,以双侧肺静脉完全隔离及左心房顶部线完全阻滞为消融终点。术后通过门诊随访24~36个月,计算两组的消融成功率,比较两组手术时间以及X线曝光时间、术后并发症发生率,术后6个月采用心脏彩超检查评价左心房功能。结果两组手术时间和X线曝光时间差异均无统计学意义(P均0.05)。CPVI组、CPVI+LARA组消融成功率分别为73.8%(62/84)、86.7%(78/90),CPVI+LARA组消融成功率高于CPVI组(P0.05)。两组术后并发症发生率差异无统计学意义(P0.05)。两组术后左心房前后径均低于术前,左心室射血分数均高于术前(P均0.01)。结论 CPVI+LARA可较CPVI显著提高阵发性房颤的消融成功率,能改善心功能,且不增加手术时间及术中X线曝光时间。
[Abstract]:Objective to compare the clinical effects of two different radiofrequency catheter ablation (RFCA) methods: CPVI) and CPVI combined with linear ablation of left atrial top (LTA) in the treatment of paroxysmal atrial fibrillation (AF). Methods 174 patients with paroxysmal atrial fibrillation who were treated with RFCA because of ineffective or intolerable antiarrhythmic drugs were selected. According to the different types of ablation, CPVI was divided into CPVI group (n = 84), CPVI group (n = 90), CPVI group (n = 90). The end point of ablation was complete isolation of bilateral pulmonary veins and complete block of the parietal line of left atrium. The successful rate of ablation was calculated, the time of operation, the time of X-ray exposure, the incidence of postoperative complications and the left atrial function were evaluated by echocardiography 6 months after operation. Results there was no significant difference in the operative time and X-ray exposure time between the two groups. The successful rate of ablation in CPVI LARA group was 73.8%. The successful rate of ablation in CPVI LARA group was higher than that in CPVI group (86.7% / 90%), and that in CPVI LARA group was higher than that in CPVI group (P 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P 0.05). The anterior and posterior diameter of left atrium in both groups was lower than that before operation, and the ejection fraction of left ventricle was higher than that before operation (P < 0.01). Conclusion CPVI Lara can significantly improve the success rate of ablation of paroxysmal atrial fibrillation, improve cardiac function, and not increase the operative time and X-ray exposure time of paroxysmal atrial fibrillation.
【作者单位】：南方医科大学珠江医院;
【基金】：南方医科大学临床启动计划项目(LC2016ZD022)
【分类号】：R541.75

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