论文部分内容阅读
目的 评价左房后壁双盒式消融(PWDB)术式对合并左房前后径(LAD)扩大阵发性心房颤动(简称房颤)患者的疗效.方法 连续入选在本院行射频消融治疗的阵发性房颤合并LAD扩大患者65例,随机分为PWDB组(n=34)和肺静脉隔离(PVI)组(n=31).PWDB组在右侧环肺静脉消融隔离后,自右侧消融环顶点行心房顶部线、左肺静脉嵴部和后壁线消融至右侧消融环底部,形成囊括右肺静脉和左房后壁大部的两个区域.PVI组沿双侧肺静脉前庭行电学隔离.对比观察两组临床一般情况、手术总时间、X线曝光时间、消融时间、围术期并发症例数.随访12个月,对比观察消融成功率、LAD变化和不良事件.结果 两组临床一般情况对比无差异.与PVI组相比,PWDB组手术总时间[(168.8±20.8) min vs (140.3±22.5) min,P＜0.001]和消融时间延长[(39.0±6.1)min vs (33.1±6.5) min,P＜0.001)].两组X线曝光时间[(21.6±4.3) min vs (20.1±3.5) min,P=0.132)]和围术期并发症事件(1例vs 0例,P=1.000)无差异.12个月随访期内,PWDB组26例(76.5％)维持窦性心律,PVI组17例(54.8％)维持窦性心律,差异有显著性(P=0.043).两组间不良事件发生例数(2例vs 3例,P=0.663)无差异.对随访期内无复发患者进行亚组分析,LAD在PWDB组有减小趋势(P-o.ool),PVI组未见明显变化(P=0.583).结论 对于合并LAD扩大的阵发房颤,PWDB术后12个月成功率显著高于PVI术式,值得临床推广应用.“,”Objective To compare the efficacy of left atrial posterior wall dual box ablation(PWDB) and pulmonary vein isolation(PVI)abtation for paroxysmal atrial fibrillation(AF) patients with left atrial diameter(LAD) enlarged.Method Sixty-five paroxysmal AF patients with LAD enlarged,who received treatment in affiliated hospital of the Armed Police Force Logistics College,were enrolled and randomly divided into PWDB group (n=34) and PVI group (n=31).In PWDB group,circumferential right pulmonary vein isolation was performed as a first step and subsequently underwent linear radiofrequency lesions from the superior pole of the right superior pulmonary veins to the left,creating a transverse roof line plus an left pulmonary vein anterior antrum line and an additional transverse linear lesion linking the inferior aspect of the inferior pulmonary veins to complete dual-box ablation on the left atrial posterior wall.In PVI group,bilateral PVI alone by circumferential ablation was done.The clinical general data,total procedure time,X-ray exposure time,ablation time and the cases of complication were observed.During a 12-month follow-up period,the success rate of ablation,LAD changes and adverse events were compared between both groups.Results The clinical general data had no difference in both groups.Compared to PVI group,the total time [(168.8 ± 20.8) min vs (140.3±22.5) min,P＜0.001],ablation time [(39.0±6.1) min vs (33.1±6.5) min,P＜0.001] were prolonged in PWDB group.X-ray exposure time [(21.6±4.3) min vs (20.1±3.5) min,P=0.132] and case of complication (1 case vs 0 case,P=I.000) had no difference.26 patients (76.5％) in PWDB group and 17 patients (54.8％) in PVI group were free from AF during the follow-up time,the difference was statistically significant (P =0.043).The adverse events had no difference (2 cases vs 3 cases,P =0.663).The LAD of those patients maintaining sinus rhythm within follow-up period in PWDB group had a decreasing trend (P =0.001),Which had no significant changes in the control group (P=0.583).Conclusion The PWDB strategy is safe and more effective than PVI alone for paroxysmal AF patients with enlarged LAD.