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目的报道应用压力感知消融导管进行环肺静脉隔离术(CPVI)治疗阵发性心房颤动(简称房颤)的远期疗效。方法总计连续206例非瓣膜病性阵发性房颤患者,其中前103例接受非压力感知的冷盐水灌注射频导管消融(对照组),后103例接受压力感知的冷盐水灌注射频导管消融(ST组)。两组的消融策略均为三维电解剖标测系统(CARTO)指导下的CPVI。对比两组放电时间、X线透视时间,每例患者的随访时间均为18个月。结果随访18个月,ST组(92/103)的成功率显著高于对照组(76/103)成功率(89.3%vs 73.8%,P=0.004)。14例术后复发患者接受了再次导管消融术,其中ST导管组5例,对照导管组9例。前者的肺静脉传导远期恢复率显著低于后者[30%(6/20)vs 63.9%(23/36),P=0.025]。对影响单次消融手术成功率的多因素进行分析显示,术中使用ST导管为影响预后的独立相关因素(P=0.006;OR 2.9;95%CI 1.35~6.23)。结论和非压力感知冷盐水灌注消融导管相比,使用具有压力感知功能的冷盐水灌注消融导管对阵发性房颤患者进行CPVI具有更低的肺静脉传导恢复率和更高的随访成功率。
Objective To report the long-term efficacy of circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (AF) with pressure-sensing ablation catheter. METHODS: A total of 206 consecutive patients with non-valvular paroxysmal atrial fibrillation were enrolled. Among them, the first 103 patients underwent non-pressure-sensing cold saline infusion radiofrequency catheter ablation (control group), and the other 103 received pressure-sensitive cold saline infusion radiofrequency catheter ablation ST group). The ablation strategies of both groups were CPVI under the guidance of CARTO. The discharge time and X-ray time of the two groups were compared, and the follow-up time of each patient was 18 months. Results After a follow-up of 18 months, the success rate of ST group (92/103) was significantly higher than that of control group (76/103) (89.3% vs 73.8%, P = 0.004). Fourteen patients with recurrent catheterization underwent re-catheter ablation, including 5 in the ST catheter group and 9 in the control catheter group. The former’s pulmonary venous conduction in the long-term recovery rate was significantly lower than the latter [30% (6/20) vs 63.9% (23/36), P = 0.025]. Analysis of multiple factors affecting the success rate of a single ablation procedure showed that intraoperative use of ST catheter was independently associated with prognosis (P = 0.006; OR 2.9; 95% CI 1.35-6.23). Conclusions CPVI has a lower rate of pulmonary venous conduction recovery and a higher follow-up success rate in patients with paroxysmal atrial fibrillation compared with non-pressure-sensitive cold saline perfusion ablation catheters.