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目的探讨应用新型Achieve环状标测导管在心房颤动(AF)冷冻球囊消融(CBA)过程中,实时监测肺静脉隔离(PVI)的作用。方法回顾分析2014年5月至2014年11月,在瑞金医院使用28mm冷冻球囊(CB)进行消融的61例阵发性AF患者。房间隔穿刺后,将带有Achieve环状标测导管的CB置于左房(LA)内,进行肺静脉电位(PVP)的标测和消融。结果 61例患者的244根肺静脉中有240根(98.4%)达到成功PVI,其中196根肺静脉(80.3%)可于消融中实时监测PVI(91.8%LSPV,82.0%LIPV,86.9%RSPV,60.7%RIPV)。在可实时监测PVI的196根静脉中,按照术中LA-PV传导恢复情况分为早期传导恢复(LAPVR)组和传导未恢复(nLAPVR)组。LAPVR组的平均PVI时间为(89±39.3)s,显著长于nLAPVR组(41±17.9)s,P<0.01。且LAPVR组最低冷冻温度为(-42±4.3)℃,显著高于nLAPVR组(-48±13.3)℃,P<0.05。预测术中持续PVI最佳界值为53s(灵敏度83%,特异度75%,曲线下面积0.894,P<0.05)。结论新型Achieve环状标测导管不仅可用于判断PVI;还可以通过实时记录PVI时间,预测术中LA-PV早期传导是否容易恢复。
Objective To investigate the effect of real-time monitoring of pulmonary venous isolation (PVI) during the atrial fibrillation (AF) cryosurgery ablation (CBA) using the new Achieve ring mapping catheter. Methods A retrospective analysis of 61 patients with paroxysmal AF using a 28mm frozen balloon (CB) at Ruijin Hospital from May 2014 to November 2014 was performed. After atrial septal puncture, the CB with the Achieve ring mapping catheter was placed in the left atrium (LA) for pulmonary vein potential (PVP) mapping and ablation. RESULTS: Of the 244 patients (98.4%) in the 61 patients who achieved successful PVI, 196 of them (80.3%) were able to monitor PVI in real time during ablation (91.8% of LSPV, 82.0% of LIPV, 86.9% of RSPV, 60.7% RIPV). Among the 196 veins with real-time monitoring of PVI, they were divided into early conduction recovery (LAPVR) group and nLAPVR group according to intraoperative LA-PV conduction recovery. The average PVI time in LAPVR group was (89 ± 39.3) s, significantly longer than that in nLAPVR group (41 ± 17.9) s, P <0.01. The lowest freezing temperature in LAPVR group was (-42 ± 4.3) ℃, which was significantly higher than that in nLAPVR group (-48 ± 13.3) ℃, P <0.05. The best predictive value of intraoperative continuous PVI was 53s (sensitivity 83%, specificity 75%, area under the curve 0.894, P <0.05). Conclusion The new Achieve ring mapping catheter can not only be used to judge PVI, but also can be used to record the PVI time in real time to predict whether the early conduction of LA-PV during operation is easy to recover.