作者：马彦卓，侯广道，汝磊生，唐丽娜，齐书英

单位：

050000 河北省石家庄市，中国人民解放军白求恩国际和平医院心内科；通信作者：齐书英；E-mail：qsy304@126.com

关键词：

心房颤动；消融技术；肺静脉隔离；消融指数；接触压力参数；治疗结果

Keywords：

Atrial fibrillation；Ablation techniques；Pulmonary vein isolation；Ablation index；Contact force；Treatment outcome

CLC：

R 541.75

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.002

Funds：

河北省医学科学研究重点课题（20150372）

摘要：

背景　既往射频消融术治疗心房颤动主要根据术者的临床经验进行操作，而量化消融评价指标的出现可以缩短手术时间，提高手术成功率，减少并发症的发生。目的　研究消融指数（AI）指导下射频消融术治疗心房颤动的有效性及安全性，以期为 AI 指导下射频消融术治疗心房颤动提供临床依据。方法　选取 2018 年 10 月—2019 年5 月于中国人民解放军白求恩国际和平医院心血管内科行射频消融术的心房颤动患者 69 例为研究对象。采用随机数字表法将患者分为试验组（41 例，在 AI 指导下行射频消融术）和对照组（28 例，在接触压力参数指导下行射频消融术）。比较两组一般资料、手术相关指标〔包括手术总时间、X 线透视时间、肺静脉隔离（PVI）单圈隔离情况、电复律使用情况、手术相关并发症发生情况〕、近期（术后 3 个月）复发情况，并记录试验组术中实际使用的 AI。结果　试验组手术总时间、X 线透视时间短于对照组（P<0.05）；两组 PVI 单圈隔离率、电复律使用率、手术相关并发症发生率比较，差异无统计学意义（P>0.05）。两组近期复发率比较，差异无统计学意义（P>0.05）。试验组术中实际使用的AI，左心房后壁多为 370，功率为 30 W；环肺底部多为 370，功率为 30 W；左心房前壁多为 420，功率为 35 W；左心房顶部多为 390~420，功率为 30 W；脊部多为 420，功率为 30 W。结论　AI 指导下射频消融术治疗心房颤动缩短了手术总时间和 X 线透视时间，且不增加 PVI 单圈隔离率、电复律使用率、手术相关并发症发生率、近期复发率，有益于术者安全、高效地完成手术。

Abstract：

Background　Radiofrequency ablation of atrial fibrillation is performed mainly according to the clinicalexperience of the operator previously.However，the successful rate is increasing，the procedural time and the occurrence ofcomplications are decreasing with the emergence of quantitative index of ablation.Objective　To evaluate the efficacy and safetyof radiofrequency ablation guided by ablation index（AI）on atrial fibrillation，in order to provide clinical evidence for AI-guided radiofrequency ablation in the treatment of atrial fibrillation.Methods　From October 2018 to May 2019，69 patients withatrial fibrillation who underwent radiofrequency ablation in the Department of Cardiology of Bethune International Peace Hospitalwere selected.Patients were randomly divided into experimental group（n=41，patients who underwent AI-guided radiofrequencyablation）and control group〔n=28，patients who underwent contact force（CF）-guided radiofrequency ablation〕.Thebaseline characteristics，procedure related indicators（including total procedure time，X-ray fluoroscopy time，single loop rateof PVI，use of electrical cardioversion，complications associated with the procedure）and recent recurrence（3 months afterprocedure）were compared between the two groups.The AI values used in the experiment group were also recorded.Results　Thetotal procedure time and X-ray fluoroscopy time of the experimental group were shorter than those of the control group（P<0.05）.There was no significant difference in single loop rate of PVI，electrical cardioversion rate，and incidence of complicationsassociated with the procedure between the two groups（P>0.05）.The recent recurrence rate was similar between the two groups（P>0.05）.In the experimental group，most of the AI used in the procedure was 370 in the posterior wall of left atrium，30 Win power；370 in the bottom of annulus lung，30 W in power；420 in the anterior wall of left atrium，35 W in power；390-420 in the top of left atrium，30 W in power；420 in the ridge，30 W in power.Conclusion　AI-guided radiofrequency ablationcan shorten the total procedure time and X-ray fluoroscopy time.While single loop rate of PVI，electrical cardioversion rate，complications associated with the procedure and recent recurrence rate were not affected.Therefore，it is beneficial to the surgeonto complete the procedure safely and efficiently.

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