摘要
目的 观察并比较单纯透视、经食管超声心动图(TEE)和心腔内超声心动图(ICE)在心房颤动(房颤)射频消融联合左心耳封堵(一站式)手术中的安全性与有效性.方法 本研究为前瞻性非随机对照研究.将2018年4月至2021年11月在河北医科大学第二医院心内一科接受一站式手术的非瓣膜性房颤患者分为3组,包括单纯透视(极简式组)、应用透视结合TEE(TEE组)和应用透视结合ICE(ICE组).分别比较3组手术成功率、手术时间、曝光量、左心耳封堵器压缩比、围手术期相关并发症(死亡、脑卒中、心包积液、出血)、术后3个月封堵器残余分流、封堵器相关血栓、1年内房颤复发,脑梗死发生等指标.结果 共纳入152例患者.其中极简式组49例,男31例,年龄(63.53±8.06)岁;TEE组58例,男33例,年龄(64.33±9.45)岁;ICE组45例,男25例,年龄(63.60±7.21)岁.3组患者在性别、年龄、既往史(高血压、糖尿病、心力衰竭、脑梗死)的发生率方面差异无统计学意义.与TEE组、ICE组相比,极简式组患者手术时间更短[(143.60±26.96)min对(174.62±24.70)min 对(158.84±26.07)min,P＜0.001],但手术 X 线曝光量高[(328.25±131.63)mGy对(245.04±114.27)mGy 对(205.44±83.90)mGy,P＜0.001],造影剂用量高(150.26±66.94)ml 对(155.71±36.15)ml对(101.21±25.59)ml,P＜0.001].从封堵器压缩比来看,极简式组的封堵器压缩比低于TEE组及ICE组(18.72％±3.20％对 21.18％±2.84％对 20.21％±3.39％,P＜0.001).3组之间术中植入失败、封堵器尺寸更换及围手术期并发症的发生率差异无统计学意义.3组患者随访(12.4±2.3)个月,极简式组9 例患者1年内复发(18.37％,9/49),TEE组12例(20.69％,12/58),ICE组8例(17.78％,8/45).1年内共有5例患者出现脑梗死,其中极简式组2例,ICE组2例,TEE组1例.2例患者出现术后封堵器相关血栓,均发生在TEE组.3组间3个月封堵器残余分流的总发生率差异无统计学意义(P=0.385),3组均没有发现＞5 mm的残余分流.结论 单纯透视下的极简式手术方案在房颤射频消融联合左心耳封堵的手术当中是安全可行的,可以明显缩短手术时间,没有增加手术相关并发症及术后残余分流的发生率.
Abstract
Objective To observe and compare the safety and effectiveness of fluoroscopy only,transesophageal echocardiography(TEE)and intracardiac echocardiography(ICE)in radiofrequency ablation combined with left atrial occlusion(one-stop procedure)for atrial fibrillation.Methods This was a prospective non-randomized controlled study.Patients with non-valvular atrial fibrillation who received one-stop procedure in the Department of Cardiology,The Second Hospital of Hebei Medical University from April 2018 to November 2021 were included,and divided into 3 groups,including simple fluoroscopy(fluoroscopy only group),fluoroscopy combined with TEE(TEE group),and fluoroscopy combined with ICE(ICE group).The procedure success rate,procedure time,fluoroscopy dose,left atrial appendage occluder compression ratio,periprocedure complications(death,stroke,pericardial effusion,hemorrhage),occluder residual shunt 3 months after procedure,occluder related thrombi,recurrence of atrial fibrillation within 1 year,occurrence of cerebral infarction and other indicators were compared among 3 groups.Results A total of 152 patients were included.There were 49 cases,31 males,aged(63.53±8.06)years in the fluoroscopy only group,58 cases,33 males,aged(64.33±9.45)years in the TEE group,and 45 cases,25 males,aged(63.60±7.21)years in the ICE group.There was no statistical difference in the incidence of gender,age,medical history(hypertension,diabetes,heart failure,cerebral infarction)among 3 groups.Compared with TEE group and ICE group,the procedure time of patients in the group was shorter[(143.60±26.96)min vs.(174.62±24.70)min vs.(158.84±26.07)min,P＜0.001].However,the fluoroscopy dose[(328.25±131.63)mGy vs.(245.04±114.27)mGy vs.(205.44±83.90)mGy,P＜0.001]and contrast agent was high[(150.26±66.94)ml vs.(155.71±36.15)ml vs.(101.21±25.59)ml,P＜0.001]in fluoroscopy only group.The compression ratio in fluoroscopy only group was lower than that in TEE group and ICE group(18.72％±3.20％vs.21.18％±2.84％vs.20.21％±3.39％,P＜0.001).There was no significant difference in the incidence of implant failure,device resizing and peri-procedure complications among the three groups.The median follow-up time of patients in the three groups was(12.4±2.3)months.Recurrence occurred within 1 year in 9 patients in the fluoroscopy only group(18.37％,9/49),12 patients in the TEE group(20.69％,12/58),and 8 patients in the ICE group(17.78％,8/45).Cerebral infarction occurred in 5 patients within 1 year,2 in the fluoroscopy only group,2 in the ICE group,and 1 in the TEE group.Device related thrombus occurred in 2 patients,both in the TEE group.There was no difference in the overall 3-month incidence of peri-device leak(PDL)among the three groups(P=0.385),and no residual shunt larger than 5 mm was found in all three groups.Conclusion Fluoroscopy only is safe and feasible in atrial fibrillation radiofrequency ablation combined with left atrial appendage occlusion,which can significantly shorten the procedure time and fluoroscopy does without increasing the incidence of procedure-related complications and post-procedure residual shunt.
基金项目
河北省自然科学基金(H2020206081)
京津冀基础研究合作专项基金(H2020206646)
NETL
NSTL
万方数据