不同类型心房颤动患者三尖瓣峡部传导时间的比较
发布时间：2018-07-27 21:10
【摘要】：目的:心房颤动(atrial fibrillation,AF,简称房颤)是临床上最常见的心律失常,给患者生活质量带来严重影响。房颤的导管射频消融已成为药物难治性房颤患者的主要治疗方式。对于持续性心房颤动,目前国内外指南皆推荐需要在双侧环肺静脉消融基础上进行心房基质改良,包括左心房顶部线消融、二尖瓣峡部消融或三尖瓣峡部消融等。然而近期研究发现额外消融不能增加手术成功率,且额外增加手术时间及风险。因此慢性房颤是否需要就行三尖瓣线性消融目前没有标准。本研究旨在研究不同类型心房颤患者三尖瓣峡部传导时间特点,探讨其对房颤导管消融的指导意义。方法:选取2015年12月至2016年10月于大连医科大学附属第一医院及大连大学附属中山医院通过导管射频消融术(RFCA)进行节律控制的阵发性室上速、预激综合征、阵发性房颤、持续性房颤或合并典型房扑的患者。排除合并甲状腺功能亢进症,心房内血栓,严重肝肾功能不全,心脏瓣膜中度以上狭窄或关闭不全所致房颤,多次射频消融术后患者,心房疤痕较多及外科三尖瓣置换及消融术后患者。将其分为对照组(normal)(阵发性室上速和预激综合征患者),AF组包括阵发性房颤亚组(paAF)及持续性房颤亚(peAF)组。以600ms的频率起搏冠状窦近端,起搏状态下消融电极标测三尖瓣环,记录起搏状态下三尖瓣环各点激动时间,X线左前斜(LA045°)5:30到7:30钟的激动时间为三尖瓣环峡部传导时间(cavotricuspid isthmus conduction time,ICT)。并计算三尖瓣环峡部传导时间与三尖瓣环传导时间(tricuspid valve annulus conduction time,TCT)比值。TCT=(Tmax-Tmin)×2,即最大值与最小值差值的两倍为TCT。三尖瓣环峡部传导时间比例(cavotricuspid isthmus conduction time Proportion,ICP)为峡部传导时间与三尖瓣环时间的比值,ICP =ICT/TCT。结果:1.三组间基线资料比较:normal组与paAF组、peAF组总体比较还是两组内亚组间分别比较,基线资料如性别、年龄、高血压、糖尿病均无明显统计学差异(P0.05)。2.三组间 TCT 比较:TCT 分别为 normal 组(68.47 ±21.3)、paAF(63.74±19.23)、peAF(87.48±17.68)。与normal组相比,AF组与正常对照组相比TCT增长(P0.05),而paAF组与正常对照组则无明显改变(P=0.153)。在AF组中peAF亚组明显长于paAF组(P0.05))。3.三组间 ICT 比较:ICT 分别为 normal 组(23.31 ± 17.61)、paAF(26.17±19.43)、peAF(53.26 ±21.90)。与 normal 组相比,AF 组 ICT 延长(P0.05),且peAF组与normal组相比传导速度明显减慢(P0.05)。在AF组中,paAF组长于paAF组(P0.05)。4.三组间 ICP 比较:ICP 分别为 normal 组(0.194 ± 0.0642)paAF 组(0.267±0.0771)peAF组(0.372 ±0.0712)。AF 组与 normal 组相比 ICP 明显增大(P0.05),peAF组与正常对照组组相比明显增大(P0.05)。在AF组中,peAF 组大于 paAF 组(P0.05)。结论:1.AF组患者其TCT、ICT均长于normal组患者,且peAF组患者更长,提示房颤可使心房重构,导致三尖瓣及三尖瓣峡部传导时间均延长。2.AF组患者其ICP均大于normal组患者,且peAF组患者更大,提示房颤导致三尖瓣环传导时间延长以三尖瓣环峡部传导时间延长为主。3.提示房颤患者三尖瓣环传导时间延长,特别三尖瓣环峡部传导时间延长,消融术中进行峡部干预可能是必需的。
[Abstract]:Objective: atrial fibrillation (AF) is the most common arrhythmia in clinic, which has a serious effect on the quality of life in patients. Catheter radiofrequency ablation of atrial fibrillation has become the main treatment for patients with refractory atrial fibrillation. For persistent atrial fibrillation, both domestic and foreign guidelines are currently recommended for bilateral CF. Amelioration of atrial matrix on the basis of venous ablation, including left atrio roof line ablation, mitral isthmus ablation, or three apical isthmus ablation. However, recent studies have found that extra ablation does not increase the success rate of the operation and increases the operation time and risk. Therefore, there is no need for three tip linear ablation for chronic atrial fibrillation. The purpose of this study was to study the characteristics of the three apical isthmus conduction time in patients with different types of atrial fibrillation and to explore the guiding significance of the catheter ablation of atrial fibrillation. Methods: the rhythmic control was carried out by catheter radiofrequency ablation (RFCA) in the First Affiliated Hospital of Dalian Medical University and the affiliated Zhongshan Hospital Affiliated to Dalian University from December 2015 to October 2016. Paroxysmal supraventricular tachycardia, preexcitation syndrome, paroxysmal atrial fibrillation, persistent atrial fibrillation, or typical atrial flutter. Excluding hyperthyroidism, atrial thrombus, severe liver and kidney insufficiency, atrial fibrillation caused by moderate or above stenosis or insufficiency of the heart valve, patients after multiple radiofrequency ablation, more atrial scars and surgical three tips The patients were divided into control group (normal) (paroxysmal supraventricular tachycardia and preexcitation syndrome), group AF including paroxysmal atrial fibrillation (paAF) and persistent atrial fibrillation (peAF) group. At the frequency of 600ms, the near end of the coronary sinus was paced at the frequency of 600ms, and the ablation electrode was used to measure the three apical rings under the pacing state, and the points of the three apex rings at the pacing state were recorded. Excitant time, the exciting time of the X-ray left anterior oblique (LA045) from 5:30 to 7:30 am the three apical annular isthmus conduction time (cavotricuspid isthmus conduction time, ICT), and calculated the ratio of the conduction time of the three apical annular isthmus to the three apical ring conduction time (tricuspid valve annulus conduction time, TCT), which is the maximum and the minimum. The two times of the value difference was the ratio of the TCT. three apical annular isthmus conduction time (cavotricuspid isthmus conduction time Proportion, ICP) as the ratio of the isthmus conduction time to the three apical ring time, ICP =ICT/TCT. results: the comparison of the baseline data between the 1. three groups: the normal group and the paAF group, the general comparison of the peAF group or the two group of the inner subgroups, respectively, the baseline. The data such as sex, age, hypertension and diabetes were not significantly different (P0.05).2. three group TCT comparison: TCT was normal (68.47 + 21.3), paAF (63.74 + 19.23), peAF (87.48 + 17.68). Compared with the normal group, the AF group was longer than the normal control group (P0.05), but there was no significant change in the paAF group and the normal control group. In group AF, peAF subgroup was significantly longer than group paAF (P0.05) in.3. three groups, ICT compared: ICT was normal group (23.31 + 17.61), paAF (26.17 + 19.43), peAF (53.26 + 21.90). ICP comparison between the three groups: ICP was normal (0.194 + 0.0642) paAF group (0.267 + 0.0771) peAF group (0.372 + 0.0712).AF group and normal group compared with normal group, ICP increased significantly (P0.05), peAF group was significantly higher than normal control group (P0.05). Patients in group rmal, and group peAF were longer, suggesting atrial fibrillation can cause atrial remodeling, leading to three apical valves and three apical isthmus conduction time extended in group.2.AF, and the ICP in group normal was greater than that in group normal, and the patients in group peAF were larger, suggesting that atrial fibrillation leads to prolonged three apical ring conduction time with prolonged three apical isthmus conduction time prolonging.3. prompting atrial fibrillation. The extension of the three cusp ring conduction time, especially the extension of the isthmus of the three ring annulus, may be necessary for the isthmus intervention during ablation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75
，
本文编号：2149145
[Abstract]:Objective: atrial fibrillation (AF) is the most common arrhythmia in clinic, which has a serious effect on the quality of life in patients. Catheter radiofrequency ablation of atrial fibrillation has become the main treatment for patients with refractory atrial fibrillation. For persistent atrial fibrillation, both domestic and foreign guidelines are currently recommended for bilateral CF. Amelioration of atrial matrix on the basis of venous ablation, including left atrio roof line ablation, mitral isthmus ablation, or three apical isthmus ablation. However, recent studies have found that extra ablation does not increase the success rate of the operation and increases the operation time and risk. Therefore, there is no need for three tip linear ablation for chronic atrial fibrillation. The purpose of this study was to study the characteristics of the three apical isthmus conduction time in patients with different types of atrial fibrillation and to explore the guiding significance of the catheter ablation of atrial fibrillation. Methods: the rhythmic control was carried out by catheter radiofrequency ablation (RFCA) in the First Affiliated Hospital of Dalian Medical University and the affiliated Zhongshan Hospital Affiliated to Dalian University from December 2015 to October 2016. Paroxysmal supraventricular tachycardia, preexcitation syndrome, paroxysmal atrial fibrillation, persistent atrial fibrillation, or typical atrial flutter. Excluding hyperthyroidism, atrial thrombus, severe liver and kidney insufficiency, atrial fibrillation caused by moderate or above stenosis or insufficiency of the heart valve, patients after multiple radiofrequency ablation, more atrial scars and surgical three tips The patients were divided into control group (normal) (paroxysmal supraventricular tachycardia and preexcitation syndrome), group AF including paroxysmal atrial fibrillation (paAF) and persistent atrial fibrillation (peAF) group. At the frequency of 600ms, the near end of the coronary sinus was paced at the frequency of 600ms, and the ablation electrode was used to measure the three apical rings under the pacing state, and the points of the three apex rings at the pacing state were recorded. Excitant time, the exciting time of the X-ray left anterior oblique (LA045) from 5:30 to 7:30 am the three apical annular isthmus conduction time (cavotricuspid isthmus conduction time, ICT), and calculated the ratio of the conduction time of the three apical annular isthmus to the three apical ring conduction time (tricuspid valve annulus conduction time, TCT), which is the maximum and the minimum. The two times of the value difference was the ratio of the TCT. three apical annular isthmus conduction time (cavotricuspid isthmus conduction time Proportion, ICP) as the ratio of the isthmus conduction time to the three apical ring time, ICP =ICT/TCT. results: the comparison of the baseline data between the 1. three groups: the normal group and the paAF group, the general comparison of the peAF group or the two group of the inner subgroups, respectively, the baseline. The data such as sex, age, hypertension and diabetes were not significantly different (P0.05).2. three group TCT comparison: TCT was normal (68.47 + 21.3), paAF (63.74 + 19.23), peAF (87.48 + 17.68). Compared with the normal group, the AF group was longer than the normal control group (P0.05), but there was no significant change in the paAF group and the normal control group. In group AF, peAF subgroup was significantly longer than group paAF (P0.05) in.3. three groups, ICT compared: ICT was normal group (23.31 + 17.61), paAF (26.17 + 19.43), peAF (53.26 + 21.90). ICP comparison between the three groups: ICP was normal (0.194 + 0.0642) paAF group (0.267 + 0.0771) peAF group (0.372 + 0.0712).AF group and normal group compared with normal group, ICP increased significantly (P0.05), peAF group was significantly higher than normal control group (P0.05). Patients in group rmal, and group peAF were longer, suggesting atrial fibrillation can cause atrial remodeling, leading to three apical valves and three apical isthmus conduction time extended in group.2.AF, and the ICP in group normal was greater than that in group normal, and the patients in group peAF were larger, suggesting that atrial fibrillation leads to prolonged three apical ring conduction time with prolonged three apical isthmus conduction time prolonging.3. prompting atrial fibrillation. The extension of the three cusp ring conduction time, especially the extension of the isthmus of the three ring annulus, may be necessary for the isthmus intervention during ablation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75
，
本文编号：2149145
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