环形脉冲电场消融治疗阵发性心房颤动效果评估及复发因素研究
Evaluation of the effect of pulsed field ablation using circular-shaped catheter on paroxysmal atrial fibrillation and factors of recurrence
雷蕾 1赵春霞 1周宁 2汪道文 1王炎1
作者信息
- 1. 华中科技大学同济医学院附属同济医院心血管内科,武汉 430030
- 2. 首都医科大学附属安贞医院心律失常中心,北京 100029
- 折叠
摘要
目的 对比环形脉冲电场消融(脉冲消融)和传统射频消融治疗阵发性心房颤动(房颤)的效果并探究复发的危险因素.方法 本研究为随机对照研究.连续纳入2021年6月至12月华中科技大学同济医学院附属同济医院心血管内科确诊为阵发性房颤且行肺静脉隔离术的患者,按1:2匹配分为脉冲消融组和射频消融组.收集两组患者临床基线资料、血生化指标、超声心动图参数、术后并发症发生情况和随访结果,比较两组患者手术疗效、术后3年房颤复发率,分析房颤复发的危险因素.结果 共入组157例患者,年龄59(53,67)岁,其中男105例.脉冲消融组54例患者,射频消融组103例患者.脉冲消融组患者手术成功率为100％,手术时间较射频消融组短[141.0(120.0,163.5)min对77.5(65.0,110.0)min,P＜0.001],两组患者 3 年房颤复发率相近[27.78％(15/54)对 32.04％(33/103),x2=0.55,P=0.582].Lasso-Cox多因素回归分析显示:左心房内径是消融术后房颤复发的独立危险因素(HR=6.22,95％CI 3.29～11.76,P＜0.01].根据受试者特征曲线(ROC)计算各指标截断值:左心房内径为4.3 cm、左心室射血分数为60％.Kaplan-Meier生存曲线显示:左心房内径≥4.3 cm组和左心室射血分数≤60％组患者术后3年无房颤复发生存率下降,差异有统计学意义(P＜0.05).亚组分析显示:左心房内径≥4.3 cm时,脉冲消融组患者术后房颤复发率较射频消融组低,差异有统计学意义(HR=0.31,95％CI0.12～0.84,P=0.021).结论 与射频消融相比,环形脉冲消融治疗效率显著更高,复发率无明显差异,在较大的左心房内径情况下可能降低房颤复发率.
Abstract
Objective To compare the efficacy and recurrence factors of pulse field ablation(PFA)using circular-shaped catheter under three-dimensional navigation and traditional radiofrequency ablation(RFA)in the treatment of paroxysmal atrial fibrillation.Methods This clinical study was a randomized controlled trial.From June 2021 to December 2021,patients diagnosed with paroxysmal atrial fibrillation and undergoing pulmonary vein isolation procedure in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were continuously screened,and divided into two groups at a ratio of 1:2,PFA group and conventional RFA group.Clinical baseline data,blood biomarkers,echocardiography,postoperative complications and follow-up results were collected.The efficacy and 3-year atrial fibrillation recurrence rate between two groups were compared,and the risk factors for atrial fibrillation recurrence were analyzed.Results A cohort of 157 patients were included,age 59(53,67)years old,including 105 males,in which 54 patients in PFA group and 103 patients in RFA group.The surgical success rate of patients in the PFA group was 100％.The 3-year recurrence rates of atrial fibrillation between the PFA group(15/54,27.78％)and RFA group(33/103,32.04％)the difference was not statistically significant(P＜0.001).Lasso-Cox multivariate regression analysis showed that left atrial diameter is an independent risk factor for the recurrence of atrial fibrillation post ablation(HR=6.22,95％CI 3.29-11.76,P＜0.01).The cutoff values of each indicator were calculated based on the receiver operating characteristic curve(ROC):left atrial diameter was 4.3 cm,and left ventricular ejection fraction value was 60％.The postoperative recurrence-free survival rates of patients with the characteristics of left atrial diameter(≥4.3 cm)or ejection fraction(≤60％)were significantly less than the patients with left atrial diameter(＜4.3 cm)or ejection fraction(＞60％)(P＜0.05).In the subgroup analysis,patients with the characteristics of left atrial diameter≥4.3 cm had a lower recurrence rate of atrial fibrillation in the PFA group than that in the RFA gruop(HR=0.31,95％CI 0.12-0.84,P=0.021).Conclusion Compared with RFA,the three-dimensional navigation ablation therapy using a circular pulse catheter had a significantly higher efficiency without significant differences of recurrence rate.The patients with larger left atrial diameters seemed to have a lower rate of atrial fibrillation recurrence by PFA.
关键词
心房颤动/阵发性心房颤动/脉冲电场消融/三维导航/复发/风险预测Key words
Atrial fibrillation/Paroxysmal atrial fibrillation/Pulse field ablation/Three-dimensional navigation/Recurrence/Risk factor引用本文复制引用
出版年
2024
NETL
NSTL
万方数据