中国心血管病研究2024，Vol.22Issue(8) ：757-762.DOI:10.3969/j.issn.1672-5301.2024.08.016

不同消融指数指导下高功率短时程射频消融术对心房颤动患者超声心动图和并发症及术后复发的影响

Effects of high-power short-duration radiofrequency ablation under different ablation indices guidance on echocardiography,complications and postoperative recurrence in patients with atrial fibrillation

唐亮 张进鹏 陈月祥 吴妙敏
中国心血管病研究2024，Vol.22Issue(8) ：757-762.DOI:10.3969/j.issn.1672-5301.2024.08.016
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不同消融指数指导下高功率短时程射频消融术对心房颤动患者超声心动图和并发症及术后复发的影响

Effects of high-power short-duration radiofrequency ablation under different ablation indices guidance on echocardiography,complications and postoperative recurrence in patients with atrial fibrillation

唐亮 1张进鹏 1陈月祥 1吴妙敏1
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作者信息

  • 1. 517000 广东省河源市,河源市人民医院心血管内科
  • 折叠

摘要

目的 探究不同消融指数(AI)指导下高功率短时程射频消融(HPSD)术对心房颤动(AF)患者超声心动图、并发症及术后复发的影响.方法 选取2019年11月～2023年10月河源市人民医院行射频导管消融治疗的80例AF患者,采用随机数字表法分为低AI组和高AI组,各40例.2组均行AI指导下HPSD消融术治疗,低AI组消融的目标AI为前壁350～400,后壁320～350,高AI组消融的目标AI为前壁450～500,后壁350～400.比较2组围术期指标、消融效果[肺静脉隔离(PVI)情况、PVI单圈隔离率]、术中气爆(POP)声发生率、手术前后超声心动图指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、E/A比值]、复发相关标志物[可溶性生长刺激表达基因2(sST2)、尿酸(UA)、成纤维细胞生长因子-23(FGF-23)]水平、围术期严重并发症发生率、近期复发情况.结果 高AI组每点消融时间、PVI时间、左心房操作时间、手术时间均短于低AI组的[(13.42±1.28)min比(15.67±1.76)min,(26.58±3.19)min比(29.24±2.42)min,(4.37±1.25)min 比(5.16±1.38)min,(121.67±20.35)min 比(132.48±22.19)min,P＜0.05];高AI组PVI单圈隔离率高于低AI组的(87.50％比67.50％,P＜0.05),2组术中POP声发生率无显著差异(P＞0.05);术后高 AI组LVEF高于低 AI组[(69.32±2.15)％比(68.01±2.27)％,P＜0.05],LVESD、LVEDD小于低 AI组[(25.61±2.29)mm 比(27.38±2.53)mm,(44.57±2.54)mm 比(46.22±2.86)mum,P＜0.05];术后高 AI 组血清sST2、UA、FGF-23 水平均低于低 AI组[(45.86±10.29)pg/ml 比(53.01±12.30)pg/ml,(286.37±22.05)μmol/L 比(302.65±24.18)μmol/L,(165.24±22.97)pg/L 比(183.76±25.42)μg/L,P＜0.05];高 AI组围术期严重并发症发生率、术后3个月复发率分别为与低AI组比较,无显著差异(P＞0.05).结论 高AI指导下HPSD消融术治疗AF患者,能优化手术流程,增强PVI隔离效果,促进心功能恢复,抑制复发标志物表达,但近期效果及安全性与低AI相当.

Abstract

Objective To investigate the effects of high-power short-duration(HPSD)radiofrequency ablation guided by different ablation indices(AI)on echocardiography,complications and postoperative recurrence in patients with atrial fibrillation(AF).Methods A total of 80 patients with atrial fibrillation(AF)who underwent radiofrequency catheter ablation at Heyuan People's Hospital from November 2019 to October 2023 were selected and randomly divided into the low AI group and the high AI group using a random number table method,40 patients in each group.Both groups underwent HPSD ablation under AI guidance.The target AI for ablation in the low AI group was 350-400 for the anterior wall and 320-350 for the posterior wall,while the target AI for ablation in the high AI group was 450-500 for the anterior wall and 350-400 for the posterior wall.The perioperative indicators,ablation effects[pulmonary vein isolation(PVI)status,PVI single-loop isolation rate],intraoperative popping(POP)sound incidence,pre-and post-operative echocardiographic indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),E/A ratio],recurrence-related markers[soluble growth-stimulating expression gene 2(sST2),uric acid(UA),fibroblast growth factor-23(FGF-23)],perioperative severe complication rate and the recent recurrence were compared between the two groups.Results The ablation time,PVI time,left atrial operation time and operation time per point in the high AI group were shorter than those in the low AI group[(13.42±1.28)min vs.(15.67±1.76)min,(26.58±3.19)min vs.(29.24±2.42)min,(4.37±1.25)min vs.(5.16±1.38)min,(121.67±20.35)min vs.(132.48±22.19)min,P＜0.05].The single-lap isolation rate of PVI in the high AI group was higher than that in the low AI group(87.50％vs.67.50％,P＜0.05).There was no significant difference in the incidence of POP sound during the operation between the two groups(P＞0.05).The LVEF in the high Al group after the surgery was higher than that in the low AI group[(69.32±2.15)％vs.(68.01±2.27)％,P＜0.05].The LVESD and LVEDD were smaller than those in the low AI group[(25.61±2.29)mm vs.(27.38±2.53)mm,(44.57±2.54)mm vs.(46.22±2.86)mm,P＜0.05].The levels of serum sST2,UA and FGF-23 in the high AI group after surgery were lower than those in the low AI group[(45.86±10.29)pg/ml vs.(53.01±12.30)pg/ml,(286.37±22.05)μmol/L vs.(302.65±24.18)μmol/L,(165.24±22.97)μg/L vs.(183.76±25.42)μg/L,P＜0.05].The incidence of severe complications during the perioperative period and the recurrence rate 3 months after the surgery in the high AI group showed no significant difference compared with the low AI group(P＞0.05).Conclusion HPSD ablation under the guidance of high AI can optimize the surgical process,enhance the isolation effect of PVI,promote the recovery of cardiac function,and inhibit the expression of relapse markers in AF patients,and the short-term effect and safety are comparable to that of low AI.

关键词

心房颤动/消融术/消融指数/高功率/短时程/超声心动图/并发症/复发

Key words

Atrial fibrillation/Ablation/Ablation index/High power/Short-time range/Echocardiography/Complications/Recrudescence

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基金项目

河源市科技计划(230608101601993)

出版年

2024
中国心血管病研究
中国医师协会，煤炭总医院

中国心血管病研究

CSTPCD
影响因子：0.878
ISSN：1672-5301
参考文献量5
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