CAJ | 학술논문

目的：探讨应用冷冻球囊导管消融术( CBCA)行初次肺静脉电隔离( PVI)治疗心房颤动(房颤)的学习曲线、即刻有效性及安全性。方法分析2013年12月11日至2014年2月28日由单一术者利用CBCA行初次PVI治疗的连续20例房颤患者的资料。将病例按手术先后编号,观察手术时间及X线透视时间变化。并将病例分为2组(前10例：A组,后10例：B组),比较两组的手术时间、X线透视时间及即刻PVI的成功率的差异。结果20例患者[男12例,平均年龄(55．4±11．6)岁,阵发性房颤19例、持续性房颤1例)房颤病程的中位数为24个月。 A、B两组平均冷冻次数[(10．5±2．1)次对(9．3±1．7)次,P=0．180]差异无统计学意义。与A组相比,B组平均冷冻时间[(46．5±11．4)min 对(36．7±4．4)min, P=0．021]、手术时间[(150．0±27．6)min对(123．4±19．8)min, P=0．023]及X线透视时间[(62．5±15．7)min对(47．2±9．7)min, P=0．018]均减少。单纯行CBCA治疗,B组在患者水平及肺静脉水平上达到即刻PVI的成功率较A组高( P<0．05)。围术期出现1例(5%)主要并发症为膈神经麻痹( PNP)。结论应用CBCA行PVI治疗房颤具有近期安全性和即刻有效性。术者可以通过较少病例很快完成学习曲线。 PNP作为主要并发症值得注意。
목적：탐토응용냉동구낭도관소융술( CBCA)행초차폐정맥전격리( PVI)치료심방전동(방전)적학습곡선、즉각유효성급안전성。방법분석2013년12월11일지2014년2월28일유단일술자이용CBCA행초차PVI치료적련속20례방전환자적자료。장병례안수술선후편호,관찰수술시간급X선투시시간변화。병장병례분위2조(전10례：A조,후10례：B조),비교량조적수술시간、X선투시시간급즉각PVI적성공솔적차이。결과20례환자[남12례,평균년령(55．4±11．6)세,진발성방전19례、지속성방전1례)방전병정적중위수위24개월。 A、B량조평균냉동차수[(10．5±2．1)차대(9．3±1．7)차,P=0．180]차이무통계학의의。여A조상비,B조평균냉동시간[(46．5±11．4)min 대(36．7±4．4)min, P=0．021]、수술시간[(150．0±27．6)min대(123．4±19．8)min, P=0．023]급X선투시시간[(62．5±15．7)min대(47．2±9．7)min, P=0．018]균감소。단순행CBCA치료,B조재환자수평급폐정맥수평상체도즉각PVI적성공솔교A조고( P<0．05)。위술기출현1례(5%)주요병발증위격신경마비( PNP)。결론응용CBCA행PVI치료방전구유근기안전성화즉각유효성。술자가이통과교소병례흔쾌완성학습곡선。 PNP작위주요병발증치득주의。
Objective To investigate the efficacy, safety and learning curve of pulmonary vein isola-tion ( PVI) using cryoballoon catheter ablation ( CBCA) technique for atrial fibrillation ( AF) . Methods This study was carried out on a consecutive series of 20 patients who underwent primary PVI for AF using the CBCA approach performed by a single operator . Patients were coded from NO. 1 to 20 in chronological order of proce-dure and then divided into two groups: patients NO. 1 to 10 set as group A, and NO. 11 to 20 as group B. Difference of procedural time, fluoroscopic time, times of freezing and acute PVI rate only using CBCA between the two groups were compared. Results A total of 20 patients (12 male, mean age 55. 4±11. 6 years) with paroxysmal(19/20)or persistent(1/20)AF underwent PVI procedure with the cryoballoon catheter (CBC). The mean freezing times (10. 5±2. 1 vs. 9. 3±1. 7, P=0. 180) has no significant difference between group A and B. Compared with group A, the mean freezing time [ ( 36. 7 ± 4. 4 ) min vs. ( 46. 5 ± 11. 4 ) min, P=0. 021], mean procedural time[(123. 4±19. 8) min vs. (150. 0±27. 6) min, P=0. 023], and mean fluoro-scopic time [(47. 2±9. 7) min vs. (62. 5±15. 7) min, P=0. 018] were significantly shorter in group B,re-spectively. Fourteen of 20 patients (70%) and a total of 70 (87. 5%)pulmonary veins were isolated success-fully with the CBC only, the rate of acute PVI tended to be higher in group B than in group A( P<0. 05 in both level). One patient had phrenic nerve palsy(PNP) during the right inferior PVI. Conclusion CBCA for AF is safe and efficient with a short learning curve. PNP is the major complication that merit attention.