论文部分内容阅读
目的探讨肺静脉解剖变异及急性期肺静脉电传导恢复对阵发性心房颤动环肺静脉射频导管消融(下称消融)治疗远期预后的影响。方法70例药物治疗无效的阵发性心房颤动患者,术前获取CT三维重建的左心房与肺静脉解剖图,测量肺静脉支数及直径。行环肺静脉消融及急性期肺静脉电传导恢复位点消融,消融终点为消除所有肺静脉电位。随访(10.3±5.6)个月,根据随访心电图及动态心电图结果分为复发组(n=18)和未复发组(n=52)。分析比较两组肺静脉电解剖特征。结果复发组肺静脉变异(61.1%)及出现左肺静脉共干者(33.3%)较未复发组(15.3%、7.7%)高,差异有统计学意义(P<0.05),左肺静脉共干长轴直径[(25.8±0.9)mm]大于未复发组[(22.5±0.3)mm],差异有统计学意义(P<0.05),急性期肺静脉电传导恢复位点数量占比显著多于未复发组(P<0.01)。两组急性期肺静脉电传导恢复61.9%位点位于上、下肺静脉交接处,明显多于其他部位。二元logistic回归分析显示左肺静脉共干长轴直径(0R=5.007,95%CI 1.581~15.852,P<0.01)及急性期肺静脉电传导恢复位点数(OR=7.463,95%CI 1.975~28.197,P<0.01)是术后复发的独立危险因素。结论左肺静脉共干长轴直径及急性期肺静脉电传导恢复位点数与阵发性心房颤动环肺静脉消融术后复发相关。
Objective To investigate the effects of anatomical variation of pulmonary veins and recovery of pulmonary venous conduction in the acute phase on long-term prognosis of patients with paroxysmal atrial fibrillation by radiofrequency catheter ablation (hereinafter referred to as ablation). Methods Seventy patients with paroxysmal atrial fibrillation who were ineffective in medical treatment were enrolled. The left ventricle and pulmonary vein anatomy of three-dimensional CT reconstruction were obtained before operation. The number and diameter of pulmonary veins were measured. Central pulmonary vein ablation and acute pulmonary venous conduction site ablation, ablation end to eliminate all pulmonary venous potential. Follow-up was (10.3 ± 5.6) months, and was divided into recurrence group (n = 18) and non-recurrence group (n = 52) according to follow-up electrocardiogram and ambulatory electrocardiogram results. Analyze and compare the characteristics of pulmonary vein anatomy in both groups. Results The pulmonary vein variability (61.1%) and left common pulmonary artery (33.3%) in the recurrent group were significantly higher than those in the non-recurrent group (15.3%, 7.7%), the difference was statistically significant (P <0.05) (25.8 ± 0.9) mm] were significantly higher than those in the non-recurrence group (22.5 ± 0.3) mm, the difference was statistically significant (P <0.05). The proportion of the number of pulmonary vein electrical conduction recovery sites in the acute phase was significantly higher than that in the non-recurrence group (P <0.01). Two groups of acute pulmonary venous conduction 61.9% recovery in the upper and lower pulmonary vein junction, significantly more than other parts. Binary logistic regression analysis showed that the diameter of the common left pulmonary artery (OR = 5.007, 95% CI 1.581-15.852, P <0.01) and the number of pulmonary vein electrical conduction recovery sites in the acute phase (OR = 7.463,95% CI 1.975-28.197, P <0.01) was an independent risk factor for postoperative recurrence. CONCLUSIONS: The diameter of the common left common pulmonary artery and the number of acute pulmonary venous conduction sites are related to the recurrence of paroxysmal atrial fibrillation after pulmonary vein ablation.