高功率短時程射頻消融治療心房顫動臨床分析

Clinical analysis of high-power short-duration radiofrequency ablation for the treatment of atrial fibrillation

10.12408/J.issn2223-4462.2024.01.008

劉紅(LIU Hong)；劉書雷(LIU Shu Lei)；柯于梵(KE Yu Fan)；易敏慈(YI Min Ci)

心房顫動 ； 高功率短時程 ； 射頻消融 ； Atrial fibrillation ； High-power short-duration ； Radiofrequency ablation

鏡湖醫學

24卷1期（2024 / 06 / 01）

27 - 29

繁體中文;英文

目的：分析高功率短時程（high-power short-duration, HPSD）射頻消融治療心房顫動（atrial fibrillation, AF）有效性和安全性。方法：收集2022年3月～2023年3月期間，在鏡湖醫院接受HPSD射頻消融治療AF患者臨床資料，統計基本臨床資料、肺靜脈隔離（Pulmonary Vein Isolation, PVI）成功率、單圈隔離率、補點位置、消融參數（功率、壓力、消融時間、消融指數、消融導管類型等）、圍手術期併發症。術後隨訪1～12月，統計AF復發情況。結果：總計20名患者納入分析，男性9例，女性11例，陣發性AF19例，持續性AF1例。所有患者均完成PVI，成功率100%。其中右肺靜脈實現單圈隔離18例（90%），左肺靜脈實現單圈隔離16例（80%）。右肺靜脈隔離補點位置在右頂部及底部，左肺靜脈隔離補點位置在頂壁、底壁及前後壁兩肺間。手術時間（158±47.2）分鐘。17例患者跟蹤隨訪大於3個月，有2例AF復發，其他均維持竇律。3例患者跟蹤隨訪1月，均為竇律。1例患者發生假性動脈瘤，經保守治療無效，外科手術痊癒出院，無1例發生心包填塞、血栓栓塞、嚴重出血、心房食道瘺。結論：HPSD治療AF有良好療效，併發症發生率低。

Objective: To analyze the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation for the treatment of atrial fibrillation (AF). Methods: Clinical data of the patients who underwent HPSD ablation for AF in our hospital from March 2022 to March 2023 were analyzed. Patients' basic clinical data, immediate pulmonary vein isolation (PVI) success rate, single-loop isolation rate, ablation gap positions, ablation parameters (power, pressure, ablation time, ablation index, ablation catheter type, etc.), and perioperative complications were recorded. Follow-up was conducted from 1 to 12 months after surgery to determine AF recurrence. Results: A total of 20 patients were included in the analysis, including 9 males and 11 females. There were 19 cases of paroxysmal AF and 1 case of persistent AF. All patients completed pulmonary vein isolation with a success rate of 100%. Single-loop isolation was achieved in 18 cases (90%) of the right pulmonary vein and 16 cases (80%) of the left pulmonary vein. The additional ablation points for isolation of the right pulmonary veins were located at the superior and inferior walls, while for the left pulmonary veins they were located at the superior, inferior, anterior and posterior walls between the two left pulmonary vein.The mean surgery time was (158±47.2) minutes. Follow-up was conducted for more than 3 months in 17 patients, and 2 cases of AF recurrence were observed, while the rest maintained sinus rhythm. Three patients were followed up for 1 month and all maintained sinus rhythm. Only 1 patient developed an arteriovenous aneurysm, which was treated with conservative therapy and required surgical intervention before discharge, and no cases of cardiac tamponade, thromboembolism, severe bleeding, or atrio-esophageal fistula were observed. Conclusion: HPSD is an effective and safe treatment for AF.