CAJ | 학술논문

目的比较磁导航指导下心房颤动(房颤)导管消融与床旁操作消融的有效性和安全性.方法 2012年11月至2013年11月在南京医科大学附属无锡市人民医院心内科住院的78例房颤患者,分为磁导航指导下消融组(MNS组,28例)和床旁操作消融对照组(CON组,50例).MNS组穿刺房间隔后采用盐水灌注磁消融导管行左心房建模和左右肺静脉前庭电隔离,隔离后采用牛眼图确认;CON组在电解到标测(Carto)系统指导下采用常规床旁操作消融方法.记录并分析两组的手术操作时间、X线曝光时间、X线曝光量和手术相关并发症.术后3～6个月内每月随访1次动态心电图.结果 78例房颤患者均成功实施消融治疗.MNS组和CON组的手术操作时间分别为110.0～ 210.0(152.7±24.0) min和90.0～ 180.0(145.5±18.2) min(P＞0.05);MNS组和CON组X线曝光时间分别为7.5～35.0(17.2±7.3)min和15.1～61.0(30.8± 14.2) min(P＜0.05);MNS组和CON组X线曝光量为165.0～1 988.0(603.0±496.6) mGy和321.5～2 512.6(850.6±624.3) mGy(P＜0.05),而MNS组28例患者中前14例和后14例的手术X线曝光量分别为250.0～1 988.0 (810.3±583.3) mGy和165.0～715.0(396.3±159.4) mGy(P＜0.01).MNS组除1例血胸外,无其他手术相关并发症,CON组出现1例心脏压塞、1例肺静脉狭窄、1例新发腔隙性脑梗死、1例血胸和3例血肿.随访3～6个月,两组手术成功率差异无统计学意义.结论磁导航可安全有效地应用于房颤患者的导管消融.与床旁操作消融相比,手术成功率相似,但具有明显减少医患X线曝光量、缩短医生房颤导管消融学习曲线和可能降低患者手术并发症等优点.
목적 비교자도항지도하심방전동(방전)도관소융여상방조작소융적유효성화안전성.방법 2012년11월지2013년11월재남경의과대학부속무석시인민의원심내과주원적78례방전환자,분위자도항지도하소융조(MNS조,28례)화상방조작소융대조조(CON조,50례).MNS조천자방간격후채용염수관주자소융도관행좌심방건모화좌우폐정맥전정전격리,격리후채용우안도학인;CON조재전해도표측(Carto)계통지도하채용상규상방조작소융방법.기록병분석량조적수술조작시간、X선폭광시간、X선폭광량화수술상관병발증.술후3～6개월내매월수방1차동태심전도.결과 78례방전환자균성공실시소융치료.MNS조화CON조적수술조작시간분별위110.0～ 210.0(152.7±24.0) min화90.0～ 180.0(145.5±18.2) min(P＞0.05);MNS조화CON조X선폭광시간분별위7.5～35.0(17.2±7.3)min화15.1～61.0(30.8± 14.2) min(P＜0.05);MNS조화CON조X선폭광량위165.0～1 988.0(603.0±496.6) mGy화321.5～2 512.6(850.6±624.3) mGy(P＜0.05),이MNS조28례환자중전14례화후14례적수술X선폭광량분별위250.0～1 988.0 (810.3±583.3) mGy화165.0～715.0(396.3±159.4) mGy(P＜0.01).MNS조제1례혈흉외,무기타수술상관병발증,CON조출현1례심장압새、1례폐정맥협착、1례신발강극성뇌경사、1례혈흉화3례혈종.수방3～6개월,량조수술성공솔차이무통계학의의.결론 자도항가안전유효지응용우방전환자적도관소융.여상방조작소융상비,수술성공솔상사,단구유명현감소의환X선폭광량、축단의생방전도관소융학습곡선화가능강저환자수술병발증등우점.
Objective To compare the efficacy and safety of atrial fibrillation(AF)ablation guided by magnetic navigation system(MNS) and manual procedure(CON).Methods Seventy-eight AF patients enrolled in the Department of Cardiology,Wuxi Pevple's Hospital affiliafed to Nanjing Medical University from November 2012 to November 2013 were randomly divided into MNS group (n =28) and CON group (n =50),respectively.Left atrial model and both pulmonary vein isolation were performed with irrigated catheter and confirmed by bulleye software after transseptal puncture in MNS group.Routine ablation was performed in CON group.The procedure time,X-ray exposure time and dose,and procedure-related complications were recorded and analyzed.Holter recordings for once a month were done during 3 to 6 months' follow-up postoperatively.Results Ablation procedures were performed successfully in all 78 AF cases.The procedure durations in MNS group and CON group were 110.0～210.0(152.7±24.0) min and 90.0～ 180.0(145.5±18.2) min(P＞0.05).The X-ray exposure time and dose in MNS group and CON group were 7.5～35.0(17.2±7.3) min vs.15.1～61.0(30.8±14.2) min(P＜0.05) and 165.0 ～ 1 988.0(603.0±496.6) mGy vs.321.5 ～ 2 512.6(850.6±624.3) mGy(P＜0.05).However,the X-ray exposure doses in the first 14 cases and the last 14 cases in MNS group were 250.0～ 1988.0(810.3±583.3) mGy and 165.0～715.0(396.3±159.4) mGy(P＜0.01).The total complications in CON group were higher than those in MNS group though no statistical significance.The success rates were almost similar in MNS group and CON group during 3 to 6 months,follow-up postoperatively.Conclusion MNS can be effectively and safely applied in AF ablation.Compared with manual procedure,there was a similar success rate.However,it has the advantages of decreasing X-ray exposure dose,shortening the durations of doctor' s learning curve for AF ablation and potentially reducing procedural complications.