| 160 | 0 | 198 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨在心腔内超声（ICE）引导下行零射线心房颤动（简称房颤）射频消融术的可行性及安全性。方法入选我院2014年1月至2023年12月期间行房颤射频消融的患者297例，根据手术过程中是否使用ICE，分为ICE引导组与X线引导组。对比两组患者基线特征及手术相关数据。结果 ICE引导组共入组111例，X线引导组共186例。ICE引导组持续性房颤的比例更高[46(41.4%) vs 17(9.1%)]，左心房内径更大[（42.7±5.2） mm vs(39.2±4.7) mm],P值均<0.05；其他一般资料和临床基线特征均无显著差异。与X线引导组相比，ICE引导组房间隔穿刺次数、穿刺时间、X射线暴露时间明显减少或缩短，两组在并发症发生率、手术时间等方面无统计学差异。由于ICE引导组与X线引导组在房颤类型、左心房内径、射血分数等基线数据方面存在明显差异，故使用R4.3.3统计软件按1∶1进行倾向性匹配，两组各81例。与X线引导组相比，ICE引导组房间隔穿刺次数更少[（1.1±0.3） vs(1.8±1.0),P<0.05]、穿刺时间更短[（2.5±0.8） min vs(3.7±2.1) min,P<0.05]、且消融手术时间明显缩短[（191.2±47.3） min vs(228.0±60.5) min,P<0.05]。结论 ICE引导下消融治疗房颤房间隔穿刺次数少，穿刺时间短，X射线暴露时间短，且手术安全有效。
Abstract：Objective To investigate the feasibility and safety of radiofrequency ablation of atrial fibrillation under zero-radiation guidance with intracardiac echocardiography(ICE). Methods 297 patients who underwent radiofrequency ablation of atrial fibrillation in our hospital during the period from January 2014 to December 2023 were enrolled, and were divided into ICE-guided and X-ray-guided groups according to whether or not ICE was used during the procedure. Baseline characteristics and procedure-related data of patients in the two groups were compared. Results A total of 111 cases were enrolled in the ICE-guided group and 186 cases in the X-ray-guided group.The proportion of persistent atrial fibrillation was higher in the ICE-guided group [46(41.4%) vs 17(9.1%)], and the internal diameter of the left atrium was larger [(42.7±5.2) mm vs(39.2±4.7) mm], P<0.05; there were no significant differences in other general information and clinical baseline characteristics. Compared with the X-ray-guided group, the number of transseptal punctures, puncture time, and X-ray exposure time were significantly reduced or shortened in the ICE-guided group, and there were no statistically significant differences in the complication rate and operative time in either group.Since there were significant differences between the ICE-guided group and the X-ray-guided group in terms of baseline atrial fibrillation type, left atrial internal diameter, and ejection fraction, a propensity match was performed using the R4.3.3 statistical software on a 1∶1 basis for the 81 cases in each group. Compared with the X-rayguided group, the ICE-guided group had fewer transseptal puncture attempts [(1.1±0.3) vs(1.8±1.0), P<0.05], a shorter puncture shorter puncture time [(2.5±0.8) min vs(3.7±2.1) min, P<0.05], and significantly shorter ablation procedure time [(191.2±47.3) min vs(228.0±60.5) min, P<0.05]. Conclusion ICE-guided ablation for atrial fibrillation has fewer transseptal punctures, shorter puncture times, shorter X-ray exposure times, and is a safe and effective procedure.
[1] HINDRICKS G, POTPARA T, DAGRES N, et al. 2020ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS):The task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology(ESC)developed with the special contribution of the Europ-ean Heart Rhythm Association(EHRA)of the ESC[J]. Eur Heart J, 2021, 42(5):373.
[2] PARAMESWARAN R, AL-KAISEY A M, KALMAN J M. Catheter ablation for atrial fibrillation:current indications and evolving technologies[J]. Nat Rev Cardiol, 2021, 18(3):210.
[3] HAMMERSTINGL C, LICKFETT L. Safety of single transseptal puncture for ablation of atrial fibrillation:retrospective study from a large cohort of patients[J]. J Cardiovasc Electrophysiol, 2008, 19(5):e36.
[4] DESAI M, KAHALY O, ASLAM A, et al. Comprehensive strategies to minimize radiation exposure during interventional electrophysiology procedures:state-of-the-art review[J].Expert Rev Med Devices, 2020, 17(11):1183.
[5] HEIDBUCHEL H, WITTKAMPF F H, VANO E, et al.Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures[J]. Europace,2014,16(7):946.
[6] HIRSHFELD J W, FERRARI V A, BENGEL F M, et al. 2018ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging:Best practices for safety and effectiveness[J].Catheter Cardiovasc Interv, 2018, 92(2):e35.
[7]王宇，邹艾霖，孙铃，等.心腔内超声辅助心房颤动患者射频消融治疗的观察[J].中国心脏起搏与心电生理杂志，2023,37(05):410.
[8] XU J, GAO Y, LIU C, et al. Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography:A meta-analysis of observational and randomized studies[J]. J Cardiovasc Electrophysiol, 2022, 33(5):897.
[9]李鼎，苑翠珍，周旭，等.改进的三维心腔内超声指引下零射线房间隔定位穿刺法[J].中国心脏起搏与心电生理杂志，2021,35(3):234.
[10]郭嘉，高晓龙，庹忠云，等.心腔内超声在心房颤动导管消融术中的应用[J].中国心脏起搏与心电生理杂志，2022,36(05):410.
[11] YAO Y, DING L, CHEN W, et al. The training and learning process of transseptal puncture using a modified technique[J].Europace, 2013, 15(12):1784.
[12]王潇睿，郑若瑶，孙凤志，等.心房颤动伴长间歇的治疗策略：共识与争议[J].中国全科医学，2024,27(27):3331.
[13] ROSU R, CISMARU G, MURESAN L, et al. Intracardiac echocardiography for transseptal puncture. A guide for cardiac electrophysiologists[J]. Med Ultrason, 2019, 21(2):183.
[14] LIN D, CALLANS D J. Use of intracardiac echocardiography during atrial fibrillation ablation to avoid complications[J].Future Cardiol, 2015, 11(6):683.
基本信息:
DOI：10.13333/j.cnki.cjcpe.2025.05.005
中图分类号:R541.75
引用信息:
[1]陈妩明,王荣,林锋,等.心腔内超声引导零射线射频消融术治疗心房颤动单中心经验[J].中国心脏起搏与心电生理杂志,2025,39(05):393-397.DOI:10.13333/j.cnki.cjcpe.2025.05.005.