碎裂电位消融联合环肺静脉电隔离消融对持久性房颤患者心房功能的影响

白宝宝 王芳芳 刘雄涛 曾迪 廉诚 李雪

[摘要] 目的 探讨碎裂电位消融（CFAE）联合环肺静脉电隔离消融（CPVI）对持久性房颤患者心房功能的影响。方法 选择2014年3月～2017年3月在解放军空军军医大学第二附属医院接受治疗的持久性房颤患者124例，随机数字表法分为两组，CPVI组和CPVA+CFAE组，每组62例。所有入院患者均常规检查，记录两组手术时间和X线透视时间，分析比较两组患者手术结果及房颤终止后的消融情况。术后随访12个月，采用Kaplan-meier生存曲线分析两组的窦性心律维持情况。 结果 CPVI+CFAE组手术时间较CPVI组长，差异有统计学意义（P <； 0.05）。两组术后恢复及并发症发生情况比较，差异均有统计学意义（P <； 0.05）。Kaplan-meier生存曲线分析结果显示，CPVI+CFAE组较CPVI组窦性心律维持时间显著延长（P <； 0.05）。 结论 CPVI+CFAE联合消融治疗持久性房颤，消融术中终止或转变成功率高，可最大程度将持久性房颤消融终止或转变为房性心动过速，且维持率高。

[关键词] 碎裂电位消融；环肺静脉电隔离消融；持久性心房颤动；房性快速性心律失常

[中图分类号] R541 [文献标识码] A [文章编号] 1673-7210（2018）12（b）-0054-04

[Abstract] Objective To investigate the effect of complex fractionated atrial electrograms （CFAE） combined with circumferential pulmonary vein isolation （CPVI） on atrial function in patients with persistent atrial fibrillation. Methods A total of 124 patients with persistent atrial fibrillation having received treatment in the Second Affiliated Hospital of PLA Air Force Military Medical University from March 2014 to March 2017 were selected and they were divided into CPVI group and CPVA+CFAE group by random number table method， with 62 cases in each group. All the patients admitted to the hospital were routinely examined， and the operation time and X-ray fluoroscopy time of the two groups were recorded， and the operation results， ablation after the end of atrial fibrillation of the two groups were analyzed and compared. After 12 months′ follow-up， Kaplan-meier survival curve was used to analyze the maintenance of sinus rhythm in the two groups. Results The operation time of the CPVI+CFAE group was longer than that of the CPVI group， and the difference was statistically significant （P <； 0.05）. The postoperative status and complications of the two groups were compared， and the differences were statistically significant （P <； 0.05）. Kaplan-meier survival curve analysis showed that the maintenance rate of sinus rhythm in the CPVI+CFAE group was significantly higher than that in the CPVI group （P <； 0.05）. Conclusion CPVI+CFAE combined with ablation in the treatment of persistent atrial fibrillation has a high success rate in the termination or transformation during ablation， which can terminate or transform persistent atrial fibrillation into atrial tachycardia to a largest degree， and the maintenance rate is high.

[Key words] Complex fractionated atrial electrograms； Circumferential pulmonary vein isolation； Persistent atrial fibrillation； Atrial tachyarrhythmia

心房顫动（简称房颤）是临床最常见的持续性心律失常，流行病学调查显示，中国房颤总患病率为0.77%，标准化率为0.61%[1]。发生房颤的主要危险因素为年龄、高血压、心肌梗死、充血性心力衰竭等，其中年龄最为明显[2-3]。资料显示随着年龄的不断增长其发病率升高显著，≥60岁的人群中，发病率≥6%[4]。随着我国人口的老龄化、心肌梗死，房颤尤其是持久性房颤，已成为严重的公共健康问题。

射频消融已成为除药物外治疗房颤的重要方法，其中环肺静脉电隔离（circumferential pulmonary vein isolation，CPVI）研究最为广泛。自Nademanee等[5]2004年提出复杂心房碎裂电位以来，碎石电位消融（complex fractionated atrial electrograms，CFAE）引起人们的关注，为房颤消融策略的基质改良提供了重要的选择术式。本研究对持久性房颤患者采用在CPVI+CFAE进行消融，旨在为临床选择合适的新的治疗策略提供依据。……