冷冻球囊消融右下肺静脉的临床实践体会
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摘要
目的:在心房颤动(房颤)冷冻球囊消融(CBA)中,应用不同方法封堵右下肺静脉(RIPV),以评价其对肺静脉电隔离(PVI)成功率的影响及其临床价值。方法:回顾性分析2017-12-2018-10于我院心血管内科接受CBA治疗的阵发性房颤(PAF)43例,其中以采取"倒U"冷冻RIPV共24例作为试验组,非"倒U"冷冻RIPV共19例作为对照组。比较两组的单次消融RIPV电隔离成功率、双侧PVI成功率、手术时间、X线曝光时间、并发症等情况。结果:与非"倒U"冷冻法相比,采取"倒U"冷冻RIPV的单次消融电隔离率高,手术时间及X线曝光时间明显缩短,但两组的双侧PVI成功率、并发症基本一致。结论:CBA治疗房颤时,采取"倒U"冷冻RIPV提高单次消融电隔离成功率,缩短手术时间和X线曝光时间,具有良好的可操作性及安全性。
Objective:To evaluate the effect and clinical value of cryoballoon ablation(CBA)in blocking the right inferior pulmonary vein(RIPV)with different ways in patients with atrial fibrillation,and to discuss the success rate of pulmonary vein electrical isolation(PVI).Method:A retrospective analysis was made in 43 cases with paroxysmal atrial fibrillation(PAF)treated with CBA from December 2017 to October 2018.Among them,24 cases were treated with "inverted U" CBA(experimental group)and 19 cases were treated with non-"inverted U" CBA(control group).The success rates of RIPV isolation and bilateral PVI,operation time,X-ray exposure time,and complications were compared between the two groups.Result:Compared with non-"inverted U",the success rate of RIPV after a single ablation was higher,while the operation time and the X-ray exposure time were obviously shortened in patients treated with "inverted U".There was no significant statistical difference in the success rate of bilateral PVI and complications in the two groups.Conclusion:The "inverted U" freeze method can improve the success rate of RIPV after a single ablation and shorten the operation time and X-ray exposure time,which is safe and operable to operate in patients with atrial fibrillation.
Objective:To evaluate the effect and clinical value of cryoballoon ablation(CBA)in blocking the right inferior pulmonary vein(RIPV)with different ways in patients with atrial fibrillation,and to discuss the success rate of pulmonary vein electrical isolation(PVI).Method:A retrospective analysis was made in 43 cases with paroxysmal atrial fibrillation(PAF)treated with CBA from December 2017 to October 2018.Among them,24 cases were treated with "inverted U" CBA(experimental group)and 19 cases were treated with non-"inverted U" CBA(control group).The success rates of RIPV isolation and bilateral PVI,operation time,X-ray exposure time,and complications were compared between the two groups.Result:Compared with non-"inverted U",the success rate of RIPV after a single ablation was higher,while the operation time and the X-ray exposure time were obviously shortened in patients treated with "inverted U".There was no significant statistical difference in the success rate of bilateral PVI and complications in the two groups.Conclusion:The "inverted U" freeze method can improve the success rate of RIPV after a single ablation and shorten the operation time and X-ray exposure time,which is safe and operable to operate in patients with atrial fibrillation.
引文
[1]金雪娟,周京敏.心力衰竭与心房颤动共存的流行病学和相关临床研究进展[J].临床心血管病杂志,2019,35(3):199-202.
[2]Kuck KH,Brugada J,Fürnkranz A,et al.Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation[J].N Engl J Med,2016,374(23):2235-2245.
[3]Okumura K,Matsumoto K,Kobayashi Y,et al.Safety and efficacy of cryoballoon ablation for paroxysmal atrial fibrillation in Japan-Results From the Japanese Prospective Post-Market Surveillance Study[J].Circ J,2016,80(8):1744-1749.
[4]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol,2014,64(21):e1-76.
[5]Ha?ssaguerre M,Ja?s P,Shah DC,et al.Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins[J].N Engl J Med,1998,339(10):659-666.
[6]Lee G,Sanders P,Kalman JM.Catheter ablation of atrial arrhythmias:state of the art[J].Lancet,2012,380(9852):1509-1519.
[7]Calkins H,Kuck KH,Cappato R,et a1.2012 HRS/EHRA/ECAS Expert Consensus Statem ent on Catheter and Surgical Ablation of Atrial Fibrillation:recommendations for patient selection procedural techniques,patient management and follow up,deftinitions,endpoints,and research trial design[J].Europace,2012,14(4):528-606.
[8]纪托,陈海莲.冷冻球囊消融与射频消融治疗阵发性心房颤动的比较[J].中国心血管病研究杂志,2017,15(10):904-907.
[9]Su W,Orme GJ,Hoyt R,et al.Retrospective review of arctic front advance cryoballoon ablation:a multicenter examination of second-generation cryoballoon(RADI-COOL trial)[J].J Interv Card Electrophysiol,2018,51(3):199-204.
[10]Packer DL,Kowal RC,Wheelan KR,et al.Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation:first results of the North American Arctic Front(STOP AF)pivotal trial[J].J Am Coll Cardiol,2013,61(16):1713-1723.
[11]Mugnai G,Chierchia GB,de Asmundis C,et al.Comparison of pulmonary vein isolation using cryoballoon versus conventional radiofrequency for paroxysmal atrial fibrillation[J].Am J Cardiol,2014,113(9):1509-1513.
[12]Padeletti L,Curnis A,Tondo C,et al.Pulmonary vein isolation with the cryoballoon technique:feasibility,procedural outcomes,and adoption in the real world:Data from One Shot Technologies TO Pulmonary Vein Isolation(1STOP)Project[J].Pacing Clin Electrophysiol,2017,40(1):46-56.
[13]肖源,詹碧鸣,陈杰龙,等.第2代冷冻球囊与射频消融治疗阵发性心房颤动的安全性和有效性的荟萃分析[J].临床心血管病杂志,2018,34(2):169-174.
[14]Pérez-Castellano N,Fernández-Cavazos R,Moreno J,et al.The COR trial:a randomized study with continuous rhythm monitoring to compare the efficacy of cryoenergy and radiofrequency for pulmonary vein isolation[J].Heart Rhythm,2014,11(1):8-14.
[15]Squara F,Zhao A,Marijon E,et al.Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation:a multicentre European evaluation[J].Europace,2015,17(5):718-724.
[16]Cheng X,Hu Q,Zhou C,et al.The long-term efficacy of cryoballoon vs irrigated radiofrequency ablation for the treatment of atrial fibrillation:A meta-analysis[J].Int J Cardiol,2015,181:297-302.
[17]方咸宏.治疗心房颤动的新选择---冷冻球囊消融[J].实用医学杂志,2015,31(6):875-878.
[2]Kuck KH,Brugada J,Fürnkranz A,et al.Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation[J].N Engl J Med,2016,374(23):2235-2245.
[3]Okumura K,Matsumoto K,Kobayashi Y,et al.Safety and efficacy of cryoballoon ablation for paroxysmal atrial fibrillation in Japan-Results From the Japanese Prospective Post-Market Surveillance Study[J].Circ J,2016,80(8):1744-1749.
[4]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol,2014,64(21):e1-76.
[5]Ha?ssaguerre M,Ja?s P,Shah DC,et al.Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins[J].N Engl J Med,1998,339(10):659-666.
[6]Lee G,Sanders P,Kalman JM.Catheter ablation of atrial arrhythmias:state of the art[J].Lancet,2012,380(9852):1509-1519.
[7]Calkins H,Kuck KH,Cappato R,et a1.2012 HRS/EHRA/ECAS Expert Consensus Statem ent on Catheter and Surgical Ablation of Atrial Fibrillation:recommendations for patient selection procedural techniques,patient management and follow up,deftinitions,endpoints,and research trial design[J].Europace,2012,14(4):528-606.
[8]纪托,陈海莲.冷冻球囊消融与射频消融治疗阵发性心房颤动的比较[J].中国心血管病研究杂志,2017,15(10):904-907.
[9]Su W,Orme GJ,Hoyt R,et al.Retrospective review of arctic front advance cryoballoon ablation:a multicenter examination of second-generation cryoballoon(RADI-COOL trial)[J].J Interv Card Electrophysiol,2018,51(3):199-204.
[10]Packer DL,Kowal RC,Wheelan KR,et al.Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation:first results of the North American Arctic Front(STOP AF)pivotal trial[J].J Am Coll Cardiol,2013,61(16):1713-1723.
[11]Mugnai G,Chierchia GB,de Asmundis C,et al.Comparison of pulmonary vein isolation using cryoballoon versus conventional radiofrequency for paroxysmal atrial fibrillation[J].Am J Cardiol,2014,113(9):1509-1513.
[12]Padeletti L,Curnis A,Tondo C,et al.Pulmonary vein isolation with the cryoballoon technique:feasibility,procedural outcomes,and adoption in the real world:Data from One Shot Technologies TO Pulmonary Vein Isolation(1STOP)Project[J].Pacing Clin Electrophysiol,2017,40(1):46-56.
[13]肖源,詹碧鸣,陈杰龙,等.第2代冷冻球囊与射频消融治疗阵发性心房颤动的安全性和有效性的荟萃分析[J].临床心血管病杂志,2018,34(2):169-174.
[14]Pérez-Castellano N,Fernández-Cavazos R,Moreno J,et al.The COR trial:a randomized study with continuous rhythm monitoring to compare the efficacy of cryoenergy and radiofrequency for pulmonary vein isolation[J].Heart Rhythm,2014,11(1):8-14.
[15]Squara F,Zhao A,Marijon E,et al.Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation:a multicentre European evaluation[J].Europace,2015,17(5):718-724.
[16]Cheng X,Hu Q,Zhou C,et al.The long-term efficacy of cryoballoon vs irrigated radiofrequency ablation for the treatment of atrial fibrillation:A meta-analysis[J].Int J Cardiol,2015,181:297-302.
[17]方咸宏.治疗心房颤动的新选择---冷冻球囊消融[J].实用医学杂志,2015,31(6):875-878.