脉冲电场消融与射频消融治疗心房颤动的临床比较
Clinical comparison of pulsed field ablation and radiofrequency ablation of atrial fibrillation
刘铮 1左琨 1张婉菁 1刘丽凤 1王彦江 1赵林 1张建军1
作者信息
- 1. 首都医科大学附属北京朝阳医院心脏中心 高血压病研究北京市重点实验室,北京 100020
- 折叠
摘要
目的 比较心房颤动(房颤)脉冲电场消融(PFA)和射频消融(RFA)的特点、临床疗效和安全性.方法 本文为观察性研究.回顾性分析2024年5月1日至7月1日在北京朝阳医院心脏中心行房颤导管消融的患者43例,按照消融方法分为PFA组19例,RFA组24例.PFA组中14例接受六瓣花状、5例接受套圈状导管治疗.评价和比较两组患者左心房导管停留时间、手术导管停留时间、X线曝光时间,以及膈神经麻痹、溶血、胃轻瘫、心房食管瘘、肺静脉狭窄等安全性终点和术后空白期房颤复发情况.结果 PFA组患者19例,其中男13例,女6例,年龄(64.6±11.6)岁,年龄范围37～79岁;RFA组患者24例,其中男14例,女10例,年龄(68.7±7.1)岁,年龄范围54～82岁.相较于 RFA 组,PFA 组导管停留时间短[(110.8±13.2)min 对(129.0±10.8)min,P＜0.001]、X线曝光时间长[(16.84±5.27)min对(10.00±2.30)min,P＜0.001].PFA组中,套圈状导管系统左心房停留时间[(72.8±1.6)min 对(85.4±13.2)min,P=0.003]、导管停留时间[(100.0±4.5)min 对(114.6±13.1)min,P=0.002]、X线曝光时间[(9.2±0.8)min对(19.6±2.8)min,P＜0.001]短于六瓣花状导管系统.六瓣花状导管系统术后出现胆红素水平升高(6/10,60.0％)和血红蛋白水平下降(7/14,50.0％).RFA组患者发生术后胃轻瘫(5/24,20.8％)和肺静脉狭窄(3/24,12.5％).术后空白期房颤复发,PFA组(5/19,26.3％)与RFA组(3/24,12.5％)相当(P=0.432).结论 PFA与RFA房颤空白期内效果相似,PFA效率更高.PFA未见胃轻瘫和肺静脉狭窄并发症.不同PFA系统治疗时溶血现象存在差异.
Abstract
Objective To compare the procedural characteristics,effectiveness,and safety of pulsed field ablation(PFA)and radiofrequency ablation(RFA)in atrial fibrillation(AF)patients.Methods This study was an observational study.Forty-three patients who underwent AF catheter ablation at the Heart Center,Beijing Chaoyang Hospital from May 1,2024 to July 1,2024 were retrospectively analyzed,including 19 cases in the PFA group and 24 cases in RFA group by catheter ablation methods.Of the patients in the PFA group,14 underwent ablation with a hexaspline PFA catheter,while five received a circular-shaped PFA catheter.The left atrial dwell time,catheter dwell time,and X-ray fluoroscopy time were evaluated and compared,as well as safety endpoints such as phrenic nerve palsy,hemolysis,gastroparesis,atrial-esophageal fistula,pulmonary vein stenosis,and recurrence of AF in the blanking period following the procedure.Results There were 19 patients in the PFA group,including 13 males and 6 females,with an age of(64.6±11.6)years,ranging from 37 to 79 years old.There were 24 patients in the RFA group including 14 males and 10 females,with an age of(68.7±7.1)years,ranging from 54 to 82 years old.Compared with the RFA group,the PFA group exhibited a shorter catheter dwell time[(110.8±13.2)min vs.(129.0±10.8)min,P＜0.001]and a longer X-ray fluoroscopy time[(16.84±5.27)min vs.(10.00±2.30)min,P＜0.001].In the PFA group,the left atrial dwell time[(72.8±1.6)min vs.(85.4±13.2)min,P=0.003],catheter dwell time[(100.0±4.5)min vs.(114.6±13.1)min,P=0.002],and X-ray fluoroscopy time[(9.2±0.8)min vs.(19.6±2.8)min,P＜0.001]of the circular-shaped PFA catheter were shorter than those of the hexaspline PFA catheter system.Postoperative elevations in plasma bilirubin(6/10,60.0％)and reductions in hemoglobin(7/14,50.0％)were observed in the hexaspline PFA catheter group.Postoperative gastroparesis(5/24,20.8％)and pulmonary vein stenosis(3/24,12.5％)occurred in the RFA group.The recurrence of AF within blanking period post-ablation was comparable between the PFA and RFA groups,with five cases in the former and three in the latter[26.3％(5/19)vs.12.5％(3/24),P=0.432].Conclusion The clinical outcomes of PFA and RFA for the ablation of AF are similar.PFA is more efficient.Gastroparesis and pulmonary vein stenosis were not observed in the PFA group.The incidence of hemolysis phenomenon was different in different PFA systems.
关键词
心房颤动/脉冲电场消融/射频消融/六瓣花状导管/套圈状导管Key words
Atrial fibrillation/Pulsed field ablation/Radiofrequency ablation/Hexaspline pulsed field ablation catheter/Circular-shaped pulsed field ablation catheter引用本文复制引用
出版年
2024
NETL
NSTL
万方数据