Efficacy and safety of "3C4L" radiofrequency ablation strategy in patients with persistent atrial fibrillation
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摘要: 目的 本文介绍一种简称为“3C4L”的持续性心房颤动(房颤)射频消融策略，并探讨其治疗的有效性及安全性。方法 连续选取2019年11月—2021年1月就诊于河南省人民医院，诊断为持续性房颤的患者51例，对其中46例患者行“3C4L”射频消融治疗，观察所有研究对象院内及术后6个月内并发症发生及房颤复发的情况。结果 46例患者在术后6个月随访过程中，失访3例，剩余43例持续性房颤患者在接受“3C4L”射频消融治疗后，5例(11.63%)患者于院内复发，给予抗心律失常药物及电转复后均转为窦性心律，6例(13.95%)患者术后出现一过性发热，2例(4.65%)患者出现少量心包积液，5例(11.63%)患者发生心房僵硬综合征。随访6个月，窦性心律维持率为93.02%，无卒中、心房食管瘘等并发症的发生。结论 应用“3C4L”射频消融策略治疗持续性房颤能获取令人满意的成功率和复发率，且不增加并发症的发生率。
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关键词:
- 持续性心房颤动 /
- 射频消融 /
- “3C4L”消融策略 /
- 心房颤动复发 /
- 并发症
Abstract: Objective The aim of this study is to introduce an atrial fibrillation radiofrequency ablation strategy called "3C4L", and discuss the efficacy and safety of this strategy.Methods We selected 51 patients who were diagnosed with persistent atrial fibrillation from November 2019 to January 2021 in Henan Provincial People's Hospital. Forty-six of them were treated with"3C4L"radiofrequency ablation, and all the subjects were observed complications and recurrence of atrial fibrillation within 6 months after the procedures.Results Three patients were lost to follow-up during the 6-month follow-up process. The remaining 43 patients with persistent atrial fibrillation received "3C4L" radiofrequency ablation therapy. Five(11.63%) patients relapsed in the hospital. Both antiarrhythmic drugs and electro-cardioversion were converted to sinus rhythm. Six(13.95%) patients developed a transient fever after surgery, two(4.65%) patients developed a small amount of pericardial effusion, and five(11.63%) patients occurred stiff left atrial syndrome. After 6 months of follow-up, the incidence of sinus rhythm was 93.02%, and there were no complications such as stroke and atrial esophageal fistula.Conclusion The application of the "3C4L" radiofrequency ablation strategy in the treatment of persistent atrial fibrillation can achieve a satisfactory success rate and recurrence rate without increasing the incidence of complications. -
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表 1 “3C4L”射频消融策略治疗持续性房颤患者的临床基线资料
Table 1. Clinical baseline characteristics of "3C4L" ablation strategy for the treatment of patients with persistent atrial fibrillation
例(%), X±S, M(P25, P75) 项目 数值 年龄/岁 61.36±9.03 男性 21(48.8) 房颤持续时间/月 5(3，24) 合并症 高血压 14(32.56) 糖尿病 7(16.28) 卒中 0(0) 冠心病 11(25.58) 充血性心力衰竭 14(32.56) 肝、肾功能不全 1(2.33) 心脏瓣膜病 3(6.98) CHA2DS2-VASc积分/分 2.0(1.0，3.0) 超声心动图指标 左房内径/mm 42.60±6.18 左室射血分数/% 58.40±4.56 
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表 2 “3C4L”射频消融策略治疗持续性房颤患者术中相关指标
Table 2. Intraoperative indexes of "3C4L" ablation strategy for patients with persistent atrial fibrillation
例(%), X±S 指标 数值 手术时间/min 169.67±42.82 射频消融时间/min CPVI 18.69±7.15 POBI 5.96±2.61 MI 10.28±4.6 CTI 8.47±2.22 SVCI 1.04±0.27 无水酒精用量/mL 7.3±2.7 X线曝光时间/min 10.5±7.2 消融径线双向阻滞 左肺静脉 43(100.00) 右肺静脉 43(100.00) 上腔静脉 43(100.00) POBI线 40(93.02) MI心内膜射频消融 25(58.14) MI心内膜+心外膜消融 8(18.60) MI心内膜+心外膜+ EI-VOM 4(9.30) CTI 41(95.35) 消融后转复 17(39.54) 消融+伊布利特转复 13(30.23) 消融+电转复 13(30.23)
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表 3 “3C4L”射频消融策略治疗持续性房颤患者房颤复发情况统计表
Table 3. The recurrence of atrial fibrillation in patients with persistent atrial fibrillation treated with "3C4L" ablation strategy
例(%) 复发 数据 院内 5(11.63) 房颤 4(9.30) 房扑/房速 1(2.33) 复发后接受电转复治疗 1(2.33) 复发后接受AADs治疗 5(11.63) 复发后转复成功 5(11.63) 术后3个月内复发 1(2.33) 房颤 0(0) 房扑/房速 1(2.33) 术后3~6个月内复发 3(9.68) 房颤 3(9.68) 房扑/房速 0(0) 复发后接受再次射频消融治疗 0(0) 复发后接受AADs治疗 3(9.68) 复发后转复成功 1(2.33)
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