中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
8期
1089-1093
,共5页
蒋晨曦%马长生%董建增%杜昕%吴嘉慧%龙德勇%喻荣辉%汤日波%桑才华
蔣晨晞%馬長生%董建增%杜昕%吳嘉慧%龍德勇%喻榮輝%湯日波%桑纔華
장신희%마장생%동건증%두흔%오가혜%룡덕용%유영휘%탕일파%상재화
阵发性心房颤动%导管消融%长期疗效
陣髮性心房顫動%導管消融%長期療效
진발성심방전동%도관소융%장기료효
Paroxysmal atrial fibrillation%Catheter ablation%Long-term outcome
目的 比较环肺静脉隔离(CPVI)和CPVI+线性消融治疗阵发性心房颤动合并左心房扩大患者的长期疗效.方法 入选左心房内径≥40 mm的阵发性心房颤动患者188例,根据术中结果分为CPVI组(132例,CPVI后恢复窦性心律且结束手术时未诱发心房颤动心律失常者)和CPVI+线性消融组(56例,CPVI后心房颤动未终止或诱发房性心律失常的患者继续行二尖瓣环峡部线、左心房顶部线和下腔静脉-三尖瓣环峡部线消融).随访至术后3年.比较2组患者左心房内径、左心室射血分数(LVEF)、单次消融术中结果及并发症.结果 CPVI+线性消融组左心房内径大于CPVI组,差异有统计学意义[(45 ±5) mm比(43 ±3) mm,P=0.011],LVEF小于CPVI组,差异有统计学意义[(61±8)％比(64±9)％,P =0.045].CPVI+线性消融组手术时间和X线透视时间明显长于CPVI组[分别为(205 ± 67) min比(142 ±45) min;(40±16) min比(28 ±21)min,均P＜0.01].术后1年,CPVI+线性消融组单次消融成功率低于CPVI组[66.1％ (37/56)比79.5％ (105/132),P=0.047],但术后3年2组单次消融成功率差异无统计学意义[(57.7％ (32/56)比59.2％ (78/132),P=0.857].术后3年成功率差异无统计学意义[60.9％ (28/46)比59.2％ (78/132),P=0.755].结论 阵发性心房颤动合并左心房扩大患者在CPVI基础上加行线性消融近期成功率低于单纯CPVI,但远期成功率相当.
目的 比較環肺靜脈隔離(CPVI)和CPVI+線性消融治療陣髮性心房顫動閤併左心房擴大患者的長期療效.方法 入選左心房內徑≥40 mm的陣髮性心房顫動患者188例,根據術中結果分為CPVI組(132例,CPVI後恢複竇性心律且結束手術時未誘髮心房顫動心律失常者)和CPVI+線性消融組(56例,CPVI後心房顫動未終止或誘髮房性心律失常的患者繼續行二尖瓣環峽部線、左心房頂部線和下腔靜脈-三尖瓣環峽部線消融).隨訪至術後3年.比較2組患者左心房內徑、左心室射血分數(LVEF)、單次消融術中結果及併髮癥.結果 CPVI+線性消融組左心房內徑大于CPVI組,差異有統計學意義[(45 ±5) mm比(43 ±3) mm,P=0.011],LVEF小于CPVI組,差異有統計學意義[(61±8)％比(64±9)％,P =0.045].CPVI+線性消融組手術時間和X線透視時間明顯長于CPVI組[分彆為(205 ± 67) min比(142 ±45) min;(40±16) min比(28 ±21)min,均P＜0.01].術後1年,CPVI+線性消融組單次消融成功率低于CPVI組[66.1％ (37/56)比79.5％ (105/132),P=0.047],但術後3年2組單次消融成功率差異無統計學意義[(57.7％ (32/56)比59.2％ (78/132),P=0.857].術後3年成功率差異無統計學意義[60.9％ (28/46)比59.2％ (78/132),P=0.755].結論 陣髮性心房顫動閤併左心房擴大患者在CPVI基礎上加行線性消融近期成功率低于單純CPVI,但遠期成功率相噹.
목적 비교배폐정맥격리(CPVI)화CPVI+선성소융치료진발성심방전동합병좌심방확대환자적장기료효.방법 입선좌심방내경≥40 mm적진발성심방전동환자188례,근거술중결과분위CPVI조(132례,CPVI후회복두성심률차결속수술시미유발심방전동심률실상자)화CPVI+선성소융조(56례,CPVI후심방전동미종지혹유발방성심률실상적환자계속행이첨판배협부선、좌심방정부선화하강정맥-삼첨판배협부선소융).수방지술후3년.비교2조환자좌심방내경、좌심실사혈분수(LVEF)、단차소융술중결과급병발증.결과 CPVI+선성소융조좌심방내경대우CPVI조,차이유통계학의의[(45 ±5) mm비(43 ±3) mm,P=0.011],LVEF소우CPVI조,차이유통계학의의[(61±8)％비(64±9)％,P =0.045].CPVI+선성소융조수술시간화X선투시시간명현장우CPVI조[분별위(205 ± 67) min비(142 ±45) min;(40±16) min비(28 ±21)min,균P＜0.01].술후1년,CPVI+선성소융조단차소융성공솔저우CPVI조[66.1％ (37/56)비79.5％ (105/132),P=0.047],단술후3년2조단차소융성공솔차이무통계학의의[(57.7％ (32/56)비59.2％ (78/132),P=0.857].술후3년성공솔차이무통계학의의[60.9％ (28/46)비59.2％ (78/132),P=0.755].결론 진발성심방전동합병좌심방확대환자재CPVI기출상가행선성소융근기성공솔저우단순CPVI,단원기성공솔상당.
Objective To compare the long-term outcomes of circumferential pulmonary vein isolation (CPVI) and CPVI plus linear ablation in paroxysmal atrial fibrillation(PAF) patients with left atrium(LA) enlargement.Methods One hundred and eighty-eight patients of PAF with LA dimention≥40 mm were included,and CPVI was performed followed by burst pacing induction.CPVI group included 132 cases with sinus rhythm restored after CPVI and no arrhythmia induced.CPVI + linear ablation group included 56 cases among whom AF was not terminated or atrial arrhythmia was induced with mitral isthmus,LA roofline and cavo-tricuspid isthmus ablated.All patients were followed up for 3 years.Results Procedure time [(205 ± 67) min vs (142 ± 45) min,P ＜0.01] and X-ray exposure time [(40 ± 16) min vs (28 ± 21) min,P ＜ 0.01] were significantly longer in CPVI + linear ablation group.One-year successful rate after single procedure was lower in CPVI + linear group [66.1％ (37/56) vs 79.5 ％ (105/132),P =0.047],but no significant difference was observed regarding 3-year successful rate after single procedure [60.9％ (28/46) vs 59.2％ (78/132),P =0.857],as well as 3-year cumulative successful rate(69.2％ vs 66.7％,P =0.755).Conclusions In PAF patients with LA enlargement,the shortterm successful rate is lower in patients undergoing CPVI plus additional linear ablation than that in CPVI,but the long-term outcomes are equivalent.
