FTI联合VisiTag指导阵发性心房颤动导管消融疗效和安全性研究
发布时间：2018-08-21 19:29
【摘要】：背景:VisiTag是Carto3系统中记录和分析导管消融效果的工具,它能实时反馈消融中导管与组织之间的稳定性,并根据术前设置的参数自动生成消融点,术后分析不同消融点的透壁损伤程度,是一种房颤量化消融术式。FTI(Force Time Integral)是每个消融点的压力值与消融时间的积分,有相关研究报道当术中FTI参数设置在350-450g.s进行导管消融时,可以达到有效的透壁性损伤,提高房颤导管消融的成功率,降低手术并发症的发生,是一种有效和安全的消融策略。目的:探讨应用消融参数FTI联合VisiTag对阵发性心房颤动导管消融的疗效和安全性研究。方法:根据是否运用FTI联合Visitag指导阵发性心房颤动的导管消融,将2015年6月-2016年6月期间,于大连医科大学附属一院心律失常科行导管消融的100例阵发性房颤患者,按照1:1随机分为组A(n=50)和组B(n=50)。其中入选A组的患者,为FTI联合VisiTag来指导导管消融;B组的患者,未行FTI联合VisiTag指导消融。对于两组入选的100例阵发性房颤患者,采取环肺静脉消融至肺静脉电隔离的术式,并且均为同一术者全程操作完成。手术中使用的消融导管均为压力导管,均在电解剖标测系统(CARTO3)下完成房颤的导管消融。比较两组全程手术时间、肺静脉消融至电隔离时间、X线曝光时间、术中单次成功实现环肺静脉消融至完全肺静脉电隔离的成功率的差异性,对于消融术后的患者均密切随访,比较两组患者术后急性期(3个月内)及长期的房颤导管消融的成功率。统计两组患者并发症的发生率。结果:导管消融术中的急性观察中发现,A组较之B组,不仅显著减少全程手术时间(107.4±7.1 vs.143.2±17.0min,P0.05)、肺静脉消融至电隔离的时间(35.2±5.6 vs.43.5±5.8min P0.05)和X线曝光时间(2.0±1.8 vs.4.2±3.3min,P0.05),更提高单次消融肺静脉电隔离成功率(94%vs.80%,P0.05)。对于房颤导管消融术后的患者密切随访得出,A组患者在术后急性期和长期的导管消融成功率上均显著高于B组(92.0%vs.76%,P0.05;88%vs.72%,P0.05)。在并发症的发生率上,A组较之B组明显降低(0%vs.4%,P0.05))。结论:房颤导管消融的终点永远是形成有效和永久的透壁性损伤,提高导管消融术后长期的成功率。对于阵发性心房颤动患者,运用FTI联合VisiTag指导导管消融,并且当双侧消融环上80%以上消融点的FTI值在350g.s-450g.s时,不仅显著减少全程手术时间、肺静脉消融至电隔离的时间及X线曝光时间提高了单次成功实现环肺静脉至肺静脉电隔离的成功率,同时明显提高消融术后急性期和长期的成功率,并且能降低手术并发症的发生。因此,运用FTI联合VisiTag指导阵发性心房颤动的导管消融,是一种有效和安全有的消融策略,具有重要的临床指导意义。
[Abstract]:Background: VisiTag is a tool in Carto3 system to record and analyze the effect of catheter ablation. It can provide real-time feedback on the stability between catheter and tissue and automatically generate ablation points according to the parameters set before operation. The degree of transmural injury at different ablation points was analyzed postoperatively. FTI (Force Time Integral) is the integral of pressure and ablation time at each ablation point) is a quantitative ablation procedure for atrial fibrillation. It has been reported that when the parameters of FTI are set in 350-450g.s for catheter ablation during operation, It is an effective and safe ablation strategy to achieve effective transmural injury, to improve the success rate of catheter ablation of atrial fibrillation, and to reduce the incidence of surgical complications. Objective: to investigate the efficacy and safety of catheter ablation of paroxysmal atrial fibrillation (PAF) with ablation parameter FTI and VisiTag. Methods: according to whether FTI and Visitag were used to guide catheter ablation of paroxysmal atrial fibrillation (PAF), 100 patients with paroxysmal atrial fibrillation (PAF) were treated with catheter ablation from June 2015 to June 2016 in the Department of Arrhythmia, Department of Arrhythmia, affiliated to Dalian Medical University. According to 1:1, group A (n = 50) and group B (n = 50) were randomly divided into two groups: group A (n = 50) and group B (n = 50). The patients in group A were treated with FTI combined with VisiTag to guide catheter ablation. Patients in group B were not treated with FTI combined with VisiTag. 100 patients with paroxysmal atrial fibrillation in both groups were treated with annular pulmonary vein ablation to electrical isolation of pulmonary vein. Catheter ablation of atrial fibrillation was performed under the electroanatomic mapping system (CARTO3). The time of the whole operation, the time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure were compared between the two groups. The successful rate of successful ablation of circular pulmonary vein to complete electrical isolation of pulmonary vein was successfully achieved during the operation. All the patients were closely followed up after ablation. The success rate of catheter ablation in acute (3 months) and long term AF was compared between the two groups. The incidence of complications in the two groups was analyzed. Results: in the acute observation of catheter ablation, group A was compared with group B. Not only the time of operation (107.4 卤7.1 vs.143.2 卤17.0 min), the time of pulmonary vein ablation to electrical isolation (35.2 卤5.6 vs.43.5 卤5.8min P0.05) and the time of X-ray exposure (2.0 卤1.8 vs.4.2 卤3.3 min P0.05) were significantly reduced, but the success rate of single ablation of pulmonary vein electrical isolation (94vs.80) was increased (P0.05). For patients with atrial fibrillation after catheter ablation, it was found that the success rate of catheter ablation in group A was significantly higher than that in group B in acute stage and long term (P 0.05, P 0.05 vs 72P, P 0.05), and the success rate of catheter ablation in group A was significantly higher than that in group B (92.0vs.76a, P0.0588vs.72p0.05). The incidence of complications in group A was significantly lower than that in group B (P0.05). Conclusion: the end point of catheter ablation for atrial fibrillation is to form effective and permanent transmural injury and to improve the long term success rate after catheter ablation. In patients with paroxysmal atrial fibrillation, FTI combined with VisiTag was used to guide catheter ablation, and when the FTI value of more than 80% of ablation points on the bilateral ablation ring was in 350g.s-450g.s, not only the whole operation time was significantly reduced. The time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure increased the success rate of electric isolation from annular pulmonary vein to pulmonary vein successfully, and also increased the success rate of acute and long term after ablation. And can reduce the incidence of surgical complications. Therefore, using FTI combined with VisiTag to guide catheter ablation of paroxysmal atrial fibrillation is an effective and safe ablation strategy and has important clinical significance.
【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：2196126
[Abstract]:Background: VisiTag is a tool in Carto3 system to record and analyze the effect of catheter ablation. It can provide real-time feedback on the stability between catheter and tissue and automatically generate ablation points according to the parameters set before operation. The degree of transmural injury at different ablation points was analyzed postoperatively. FTI (Force Time Integral) is the integral of pressure and ablation time at each ablation point) is a quantitative ablation procedure for atrial fibrillation. It has been reported that when the parameters of FTI are set in 350-450g.s for catheter ablation during operation, It is an effective and safe ablation strategy to achieve effective transmural injury, to improve the success rate of catheter ablation of atrial fibrillation, and to reduce the incidence of surgical complications. Objective: to investigate the efficacy and safety of catheter ablation of paroxysmal atrial fibrillation (PAF) with ablation parameter FTI and VisiTag. Methods: according to whether FTI and Visitag were used to guide catheter ablation of paroxysmal atrial fibrillation (PAF), 100 patients with paroxysmal atrial fibrillation (PAF) were treated with catheter ablation from June 2015 to June 2016 in the Department of Arrhythmia, Department of Arrhythmia, affiliated to Dalian Medical University. According to 1:1, group A (n = 50) and group B (n = 50) were randomly divided into two groups: group A (n = 50) and group B (n = 50). The patients in group A were treated with FTI combined with VisiTag to guide catheter ablation. Patients in group B were not treated with FTI combined with VisiTag. 100 patients with paroxysmal atrial fibrillation in both groups were treated with annular pulmonary vein ablation to electrical isolation of pulmonary vein. Catheter ablation of atrial fibrillation was performed under the electroanatomic mapping system (CARTO3). The time of the whole operation, the time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure were compared between the two groups. The successful rate of successful ablation of circular pulmonary vein to complete electrical isolation of pulmonary vein was successfully achieved during the operation. All the patients were closely followed up after ablation. The success rate of catheter ablation in acute (3 months) and long term AF was compared between the two groups. The incidence of complications in the two groups was analyzed. Results: in the acute observation of catheter ablation, group A was compared with group B. Not only the time of operation (107.4 卤7.1 vs.143.2 卤17.0 min), the time of pulmonary vein ablation to electrical isolation (35.2 卤5.6 vs.43.5 卤5.8min P0.05) and the time of X-ray exposure (2.0 卤1.8 vs.4.2 卤3.3 min P0.05) were significantly reduced, but the success rate of single ablation of pulmonary vein electrical isolation (94vs.80) was increased (P0.05). For patients with atrial fibrillation after catheter ablation, it was found that the success rate of catheter ablation in group A was significantly higher than that in group B in acute stage and long term (P 0.05, P 0.05 vs 72P, P 0.05), and the success rate of catheter ablation in group A was significantly higher than that in group B (92.0vs.76a, P0.0588vs.72p0.05). The incidence of complications in group A was significantly lower than that in group B (P0.05). Conclusion: the end point of catheter ablation for atrial fibrillation is to form effective and permanent transmural injury and to improve the long term success rate after catheter ablation. In patients with paroxysmal atrial fibrillation, FTI combined with VisiTag was used to guide catheter ablation, and when the FTI value of more than 80% of ablation points on the bilateral ablation ring was in 350g.s-450g.s, not only the whole operation time was significantly reduced. The time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure increased the success rate of electric isolation from annular pulmonary vein to pulmonary vein successfully, and also increased the success rate of acute and long term after ablation. And can reduce the incidence of surgical complications. Therefore, using FTI combined with VisiTag to guide catheter ablation of paroxysmal atrial fibrillation is an effective and safe ablation strategy and has important clinical significance.
【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
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，本文编号：2196126
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