应用STSF导管高功率消融模式治疗老年阵发性房颤的临床疗效

来源期刊：广州医药 | 9-13 发布时间：2022-08-03 收稿时间：2025/11/13 18:19:12 阅读量：33

作者：: 谭文亮,

黎镇赐,

吴天源,

孙少喜,

关键词：: 心房颤动射频消融高功率 SFSF导管; atrial fibrillation radiofrequency ablation high-power ThermoCool SmartTouch SurroundFlow catheter

DOI：: 10.3969/j.issn.1000-8535.2022.04.003

收稿时间：: 2021-11-27
修订日期：
接收日期：
引用总数：: 2

目的探讨应用56孔冷盐水(STSF)压力导管高功率消融模式治疗老年阵发性房颤患者的有效性和围手术期安全性。方法回顾性分析广州市第一人民医院2019年1月—2021年6月使用STSF导管高功率消融模式行射频治疗的老年阵发性房颤患者68例(STSF组),匹配同期年龄、性别、左房直径、左室射血分数无差异且使用6孔冷盐水 (ST)压力导管常规功率消融的老年房颤患者71例(ST组),比较2组患者之间的即刻环肺静脉隔离成功率、单圈隔离成功率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。结果 2组患者都成功完成环肺静脉电隔离,STSF组单圈隔离成功率与ST组无差异(左侧肺静脉92.6% vs 90.1%,P>0.05;右侧肺静脉83.8% vs 87.3%,P>0.05),与ST组比较,STSF组手术及消融时间缩短[(70.9±10.0)min vs (79.1±14.2)min,P<0.001;(25.4±4.5)min vs(30.5±6.3)min,P<0.001],灌注量更低[(406.5±46.3)mL vs (729.2±106.1)mL;P<0.001],X线透视时间相近[(6.5±2.5)min vs(7.3±2.6)min;P=0.056]。2组围手术期并发症率均较低(2.9% vs 3.9%;P=0.39),STSF组2例术中发生气体爆破,但未引起心包填塞,ST组有2例术后出现心衰,利尿后好转,1例出现持续性胸痛,胃镜提示食道糜烂,予流质饮食及质子泵抑制剂治疗后恢复。结论应用STSF导管高功率消融模式在老年阵发性房颤患者行肺静脉大环隔离可提高消融效率,减少术中液体负荷,且不增加围手术期风险。

Objective To investigate the effectiveness and perioperative safety of ThermoCool SmartTouch SurroundFlow (STSF) catheter high-power ablation mode in the treatment of elderly patients with paroxysmal atrial fibrillation. Methods A total of 68 elderly patients with paroxysmal atrial fibrillation who used STSF catheter high-power ablation mode (STSF group) in Guangzhou First People's Hospital from January 2019 to June 2021 were analyzed retrospectively. There were 71 elderly patients with atrial fibrillation who had no significant difference in age, sex, left atrial diameter and left ventricular ejection fraction, used ThermoCool SmartTouch (ST) catheters for conventional power ablation (ST group) at the same time. The success rate of immediate circumferential pulmonary vein isolation, single lap isolation, operation time, X-ray fluoroscopy time, ablation time, intraoperative saline perfusion volume and the incidence of complications were compared between the two groups. Results Both groups of patients successfully completed circular pulmonary vein electrical isolation. There was no significant difference in the success rate of single-circle isolation between STSF group and ST group (left pulmonary vein 92.6% vs 90.1%, P>0.05; right pulmonary vein 83.8% vs 87.3%, P>0.05). Compared with ST group, STSF group had shorter operation and ablation time [(70.9±10.0) min vs (79.1±14.2) min, P<0.001; (25.4±4.5) min vs (30.5±6.3) min, P<0.001], lower perfusion volume [(406.5±46.3)mL vs (729.2±106.1)mL, P<0.001], similar X-ray fluoroscopy time [(6.5±2.5)min vs (7.3±2.6)min, P=0.056 ]. The perioperative complication rate of the two groups was low (2.9% vs 3.9%, P=0.39). Two cases of STSF group had steam pops during operation but did not cause pericardial tamponade, and 2 cases of ST group had postoperative heart failure occurred and improved after diuresis. One case developed persistent chest pain, which gastroscope indicated esophageal erosion, and recovered after liquid diet and PPI treatment. Conclusions Using STSF catheter high-power ablation mode to perform pulmonary vein isolation in elderly patients with paroxysmal atrial fibrillation could improve ablation efficiency, reduce intraoperative fluid load, and without increasing perioperative risk.

1、 YAVIN H D, LESHEM E, SHAPIRA-DANIELS A,et al. Impact of high-power short-duration radiofrequency ablation on long-term lesion durability for atrial fibrillation ablation[J]. JACC Clin Electrophysiol, 2020,6(8):973-985.

2、 CHEN S, CHUN K R J, TOHOKU S,et al. Esophageal endoscopy after catheter ablation of atrial fibrillation using ablation-index guided high-power[J]. JACC Clin Electrophysiol, 2020,6(10):1253-1261.

3、 CHINITZ L A, MELBY D P, MARCHLINSKI F E,et al. Safety and efficiency of porous-tip contact-force catheter for drug-refractory symptomatic paroxysmal atrial fibrillation ablation: results from the SMART SF trial[J]. Europace, 2018,20(3):392-400.

4、 PLENGE T, van DEN BRUCK J H, LüKER J, et al. Porous tip contact force-sensing catheters for pulmonary vein isolation: performance in a clinical routine setting[J]. J Interv Card Electrophysiol, 2020,57(2):251-259.

5、 TOFIELD A. The CABANA trial: A first glance at an important study[J]. Eur Heart J, 2018,39(30):2767-2768.

6、 MARROUCHE N F, BRACHMANN J, ANDRESEN D, et al. Catheter ablation for atrial fibrillation with heart failure[J]. N Engl J Med, 2018,378(5):417-427.

7、 BERTE B, HILFIKER G, RUSSI I,et al. Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter[J]. J Cardiovasc Electrophysiol, 2019,30(11):2199-2204.

8、 LESHEM E, ZILBERMAN I, TSCHABRUNN C M, et al. High-power and short-duration ablation for pulmonary vein isolation: biophysical characterization[J]. JACC Clin Electrophysiol,2018,4(4):467-479.

9、 REDDY V Y, DUKKIPATI S R, NEUZIL P,et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) study[J]. Circulation, 2015,132(10):907-915.

10、 ITOH T, KIMURA M, TOMITA H, et al. Reduced residual conduction gaps and favourable outcome in contact force-guided circumferential pulmonary vein isolation[J]. Europace,2016,18(4):531-537.

11、 CALKINS H, HINDRICKS G, CAPPATO R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J]. Heart Rhythm,2017,14(10):e275-444.

12、 BERTE B, HILFIKER G, RUSSI I,et al. Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter[J]. J Cardiovasc Electrophysiol,2019,30(11):2199-2204.

13、 KUCK K H, FüRNKRANZ A, CHUN K R, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial[J]. Eur Heart J,2016,37(38):2858-2865.

14、 ZHANG S. Atrial fibrillation in mainland China: epidemiology and current management[J]. Heart,2009,95(13):1052-1055.

1、甄一博.消融指数指导下房颤高功率射频消融有效性和安全性的Meta分析[D].河北医科大学,2023.DOI:10.27111/d.cnki.ghyku.2023.000548.

2、甄一博,郝杰,祖秀光.消融指数指导下心房颤动高功率射频消融有效性和安全性的meta分析[J].临床心血管病杂志,2023,39(04):282-289.DOI:10.13201/j.issn.1001-1439.2023.04.010.