作者：马彦卓，陈瑜，李洁，杨茜，唐丽娜，栾雪冰，张春丽，齐书英

单位：

050082河北省石家庄市，中国人民解放军联勤保障部队第九八〇医院心内科

Units：

Department of Cardiology, 980 Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, China

关键词：

心房颤动；射频消融术；肺静脉电隔离；补点消融

Keywords：

Atrial fibrillation; Radiofrequency ablation; Pulmonary vein isolation; Additional ablation

CLC：

R 541.75

DOI：

10.12114/j.issn.1008-5971.2023.00.225

Funds：

河北省医学科学研究重点课题（20210200）

摘要：

　目的　分析心房颤动射频消融术中肺静脉电隔离（PVI）后补点消融的位置及其补点消融数量。方法选取2019年2月至2022年9月在中国人民解放军联勤保障部队第九八〇医院心内科住院并进行射频消融术的心房颤动患者186例为研究对象。根据患者病史和心电图特征，将其分为阵发性心房颤动组（123例）和持续性心房颤动组（63例）。收集患者一般资料，统计患者即刻PVI成功率、补点消融位置及其补点消融数量。结果　持续性心房颤动组男性占比、饮酒率高于阵发性心房颤动组，左心室射血分数（LVEF）低于阵发性心房颤动组，左心房内径大于阵发性心房颤动组（P＜0.05）。186例心房颤动患者即刻PVI成功率为31.7%（59/186）。持续性心房颤动组即刻PVI成功率低于阵发性心房颤动组（P＜0.05）。186例心房颤动患者补点消融位置：（1）左肺静脉前庭和口部：主要为后交叉部31例（16.7%），其次为前交叉部11例（5.9%）；（2）右肺静脉前庭和口部：主要为后交叉部50例（26.9%），其次为前交叉部39例（21.0%）；（3）肺静脉后壁：主要为中部17例（9.1%），其次为右下部3例（1.6%）。持续性心房颤动组肺静脉后壁的中部补点消融者占比高于阵发性心房颤动组（P＜0.05）。186例心房颤动患者各补点消融位置的补点消融数量：（1）左肺静脉前庭和口部：前上部最多，为6.0（6.0，6.0）个点，其次为顶部6.0（3.0，8.0）个点；（2）右肺静脉前庭和口部：顶部最多，为6.5（2.5，9.8）个点，其次为前交叉部3.0（2.0，5.0）个点；（3）肺静脉后壁：中部最多，为7.0（3.0，10.0）个点，其次为左顶部4.0（4.0，4.0）个点、左下部4.0（4.0，4.0）个点。两组左肺静脉前庭和口部的后交叉部，右肺静脉前庭和口部的前交叉部、后交叉部、肺静脉间，肺静脉后壁的中部补点消融数量比较，差异无统计学意义（P＞0.05）。结论　肺静脉前庭和口部的后交叉部、后壁的中部为最常见的补点消融位置，且肺静脉后壁中部补点消融可能与心房颤动类型有关；肺静脉前庭和口部的前上部、顶部及肺静脉后壁的中部补点消融数量较多。

Abstract：

Objective To analyze the location of additional ablation and its additional ablation number after pulmonaryvein isolation (PVI) during radiofrequency ablation of atrial fibrillation. Methods A total of 186 patients with atrial fibrillationwho were hospitalized and underwent radiofrequency ablation in the Department of Cardiology of 980 Hospital of PLA JointLogistics Support Forces from February 2019 to September 2022 were selected as the study objects. The patients were dividedinto paroxysmal atrial fibrillation group (123 cases) and persistent atrial fibrillation group (63 cases) according to their medicalhistory and ECG characteristics. The general data of patients were collected, and the success rate of immediate PVI, the location ofadditional ablation and its additional ablation number were counted. Results The male proportion and drinking rate in persistentatrial fibrillation group were higher than those in paroxysmal atrial fibrillation group, the left ventricular ejection fraction (LVEF)was lower than that in paroxysmal atrial fibrillation group, and the left atrial diameter was greater than that in paroxysmal atrialfibrillation group (P < 0.05) . The immediate PVI success rate of 186 patients with atrial fibrillation was 31.7% (59/186) . Thesuccess rate of immediate PVI in persistent atrial fibrillation group was lower than that in paroxysmal atrial fibrillation group (P< 0.05) . The locations of additional ablation of 186 patients with atrial fibrillation were as follows: (1) vestibular and oral parts of left pulmonary vein: the main part was posterior chiasma in 31 cases (16.7%) , followed by anterior chiasma in 11 cases (5.9%) ;(2) vestibular and oral parts of the right pulmonary vein: the main part was posterior chiasma in 50 cases (26.9%) , followed byanterior chiasma in 39 cases (21.0%) ; (3) posterior wall of pulmonary vein: the main part was the middle part in 17 cases (9.1%) ,followed by lower right part in 3 cases (1.6%) . The proportion of the additional ablation of the middle part of the posterior wall of thepulmonary vein in the persistent atrial fibrillation group was higher than that in the paroxysmal atrial fibrillation group (P < 0.05) .In 186 patients with atrial fibrillation, the additional ablation number of each location of additional ablation was as follows: (1)vestibular and oral parts of left pulmonary vein: anterior upper part was the most [6.0 (6.0, 6.0) points] , followed by the top part [6.0(3.0, 8.0) points] ; (2) vestibular and oral parts of right pulmonary vein: the top part was the most [6.5 (2.5, 9.8) points] , followed byanterior chiasma [3.0 (2.0, 5.0) points] ; (3) posterior wall of pulmonary vein: the middle part was the most [7.0 (3.0, 10.0) points] ,followed by the left top part [4.0 (4.0, 4.0) points] and the lower left part [4.0 (4.0, 4.0) points] . There was no significant difference inthe additional ablation number of the posterior chiasma of vestibular and oral parts of left pulmonary vein, anterior chiasma, posteriorchiasma and interpulmonary vein of vestibular and oral parts of right pulmonary vein, and the middle part of the posterior wall of thepulmonary vein between the two groups (P > 0.05) . Conclusion The most common locations of additional ablation are the posteriorchiasma of vestibular and oral parts and the middle part of the posterior wall of pulmonary veins, and the additional ablation of themiddle part of the posterior wall of pulmonary veins might be related to the type of atrial fibrillation. The additional ablation numbersof the anterior upper part and top part of vestibular and oral parts and middle part of posterior wall of pulmonary veins are more.

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