FTI聯(lián)合VisiTag指導(dǎo)陣發(fā)性心房顫動導(dǎo)管消融療效和安全性研究
發(fā)布時(shí)間：2018-08-21 19:29
【摘要】：背景:VisiTag是Carto3系統(tǒng)中記錄和分析導(dǎo)管消融效果的工具,它能實(shí)時(shí)反饋消融中導(dǎo)管與組織之間的穩(wěn)定性,并根據(jù)術(shù)前設(shè)置的參數(shù)自動生成消融點(diǎn),術(shù)后分析不同消融點(diǎn)的透壁損傷程度,是一種房顫量化消融術(shù)式。FTI(Force Time Integral)是每個(gè)消融點(diǎn)的壓力值與消融時(shí)間的積分,有相關(guān)研究報(bào)道當(dāng)術(shù)中FTI參數(shù)設(shè)置在350-450g.s進(jìn)行導(dǎo)管消融時(shí),可以達(dá)到有效的透壁性損傷,提高房顫導(dǎo)管消融的成功率,降低手術(shù)并發(fā)癥的發(fā)生,是一種有效和安全的消融策略。目的:探討應(yīng)用消融參數(shù)FTI聯(lián)合VisiTag對陣發(fā)性心房顫動導(dǎo)管消融的療效和安全性研究。方法:根據(jù)是否運(yùn)用FTI聯(lián)合Visitag指導(dǎo)陣發(fā)性心房顫動的導(dǎo)管消融,將2015年6月-2016年6月期間,于大連醫(yī)科大學(xué)附屬一院心律失�？菩袑�(dǎo)管消融的100例陣發(fā)性房顫患者,按照1:1隨機(jī)分為組A(n=50)和組B(n=50)。其中入選A組的患者,為FTI聯(lián)合VisiTag來指導(dǎo)導(dǎo)管消融;B組的患者,未行FTI聯(lián)合VisiTag指導(dǎo)消融。對于兩組入選的100例陣發(fā)性房顫患者,采取環(huán)肺靜脈消融至肺靜脈電隔離的術(shù)式,并且均為同一術(shù)者全程操作完成。手術(shù)中使用的消融導(dǎo)管均為壓力導(dǎo)管,均在電解剖標(biāo)測系統(tǒng)(CARTO3)下完成房顫的導(dǎo)管消融。比較兩組全程手術(shù)時(shí)間、肺靜脈消融至電隔離時(shí)間、X線曝光時(shí)間、術(shù)中單次成功實(shí)現(xiàn)環(huán)肺靜脈消融至完全肺靜脈電隔離的成功率的差異性,對于消融術(shù)后的患者均密切隨訪,比較兩組患者術(shù)后急性期(3個(gè)月內(nèi))及長期的房顫導(dǎo)管消融的成功率。統(tǒng)計(jì)兩組患者并發(fā)癥的發(fā)生率。結(jié)果:導(dǎo)管消融術(shù)中的急性觀察中發(fā)現(xiàn),A組較之B組,不僅顯著減少全程手術(shù)時(shí)間(107.4±7.1 vs.143.2±17.0min,P0.05)、肺靜脈消融至電隔離的時(shí)間(35.2±5.6 vs.43.5±5.8min P0.05)和X線曝光時(shí)間(2.0±1.8 vs.4.2±3.3min,P0.05),更提高單次消融肺靜脈電隔離成功率(94%vs.80%,P0.05)。對于房顫導(dǎo)管消融術(shù)后的患者密切隨訪得出,A組患者在術(shù)后急性期和長期的導(dǎo)管消融成功率上均顯著高于B組(92.0%vs.76%,P0.05;88%vs.72%,P0.05)。在并發(fā)癥的發(fā)生率上,A組較之B組明顯降低(0%vs.4%,P0.05))。結(jié)論:房顫導(dǎo)管消融的終點(diǎn)永遠(yuǎn)是形成有效和永久的透壁性損傷,提高導(dǎo)管消融術(shù)后長期的成功率。對于陣發(fā)性心房顫動患者,運(yùn)用FTI聯(lián)合VisiTag指導(dǎo)導(dǎo)管消融,并且當(dāng)雙側(cè)消融環(huán)上80%以上消融點(diǎn)的FTI值在350g.s-450g.s時(shí),不僅顯著減少全程手術(shù)時(shí)間、肺靜脈消融至電隔離的時(shí)間及X線曝光時(shí)間提高了單次成功實(shí)現(xiàn)環(huán)肺靜脈至肺靜脈電隔離的成功率,同時(shí)明顯提高消融術(shù)后急性期和長期的成功率,并且能降低手術(shù)并發(fā)癥的發(fā)生。因此,運(yùn)用FTI聯(lián)合VisiTag指導(dǎo)陣發(fā)性心房顫動的導(dǎo)管消融,是一種有效和安全有的消融策略,具有重要的臨床指導(dǎo)意義。
[Abstract]:Background: VisiTag is a tool in Carto3 system to record and analyze the effect of catheter ablation. It can provide real-time feedback on the stability between catheter and tissue and automatically generate ablation points according to the parameters set before operation. The degree of transmural injury at different ablation points was analyzed postoperatively. FTI (Force Time Integral) is the integral of pressure and ablation time at each ablation point) is a quantitative ablation procedure for atrial fibrillation. It has been reported that when the parameters of FTI are set in 350-450g.s for catheter ablation during operation, It is an effective and safe ablation strategy to achieve effective transmural injury, to improve the success rate of catheter ablation of atrial fibrillation, and to reduce the incidence of surgical complications. Objective: to investigate the efficacy and safety of catheter ablation of paroxysmal atrial fibrillation (PAF) with ablation parameter FTI and VisiTag. Methods: according to whether FTI and Visitag were used to guide catheter ablation of paroxysmal atrial fibrillation (PAF), 100 patients with paroxysmal atrial fibrillation (PAF) were treated with catheter ablation from June 2015 to June 2016 in the Department of Arrhythmia, Department of Arrhythmia, affiliated to Dalian Medical University. According to 1:1, group A (n = 50) and group B (n = 50) were randomly divided into two groups: group A (n = 50) and group B (n = 50). The patients in group A were treated with FTI combined with VisiTag to guide catheter ablation. Patients in group B were not treated with FTI combined with VisiTag. 100 patients with paroxysmal atrial fibrillation in both groups were treated with annular pulmonary vein ablation to electrical isolation of pulmonary vein. Catheter ablation of atrial fibrillation was performed under the electroanatomic mapping system (CARTO3). The time of the whole operation, the time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure were compared between the two groups. The successful rate of successful ablation of circular pulmonary vein to complete electrical isolation of pulmonary vein was successfully achieved during the operation. All the patients were closely followed up after ablation. The success rate of catheter ablation in acute (3 months) and long term AF was compared between the two groups. The incidence of complications in the two groups was analyzed. Results: in the acute observation of catheter ablation, group A was compared with group B. Not only the time of operation (107.4 鹵7.1 vs.143.2 鹵17.0 min), the time of pulmonary vein ablation to electrical isolation (35.2 鹵5.6 vs.43.5 鹵5.8min P0.05) and the time of X-ray exposure (2.0 鹵1.8 vs.4.2 鹵3.3 min P0.05) were significantly reduced, but the success rate of single ablation of pulmonary vein electrical isolation (94vs.80) was increased (P0.05). For patients with atrial fibrillation after catheter ablation, it was found that the success rate of catheter ablation in group A was significantly higher than that in group B in acute stage and long term (P 0.05, P 0.05 vs 72P, P 0.05), and the success rate of catheter ablation in group A was significantly higher than that in group B (92.0vs.76a, P0.0588vs.72p0.05). The incidence of complications in group A was significantly lower than that in group B (P0.05). Conclusion: the end point of catheter ablation for atrial fibrillation is to form effective and permanent transmural injury and to improve the long term success rate after catheter ablation. In patients with paroxysmal atrial fibrillation, FTI combined with VisiTag was used to guide catheter ablation, and when the FTI value of more than 80% of ablation points on the bilateral ablation ring was in 350g.s-450g.s, not only the whole operation time was significantly reduced. The time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure increased the success rate of electric isolation from annular pulmonary vein to pulmonary vein successfully, and also increased the success rate of acute and long term after ablation. And can reduce the incidence of surgical complications. Therefore, using FTI combined with VisiTag to guide catheter ablation of paroxysmal atrial fibrillation is an effective and safe ablation strategy and has important clinical significance.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.75
本文編號：2196126
[Abstract]:Background: VisiTag is a tool in Carto3 system to record and analyze the effect of catheter ablation. It can provide real-time feedback on the stability between catheter and tissue and automatically generate ablation points according to the parameters set before operation. The degree of transmural injury at different ablation points was analyzed postoperatively. FTI (Force Time Integral) is the integral of pressure and ablation time at each ablation point) is a quantitative ablation procedure for atrial fibrillation. It has been reported that when the parameters of FTI are set in 350-450g.s for catheter ablation during operation, It is an effective and safe ablation strategy to achieve effective transmural injury, to improve the success rate of catheter ablation of atrial fibrillation, and to reduce the incidence of surgical complications. Objective: to investigate the efficacy and safety of catheter ablation of paroxysmal atrial fibrillation (PAF) with ablation parameter FTI and VisiTag. Methods: according to whether FTI and Visitag were used to guide catheter ablation of paroxysmal atrial fibrillation (PAF), 100 patients with paroxysmal atrial fibrillation (PAF) were treated with catheter ablation from June 2015 to June 2016 in the Department of Arrhythmia, Department of Arrhythmia, affiliated to Dalian Medical University. According to 1:1, group A (n = 50) and group B (n = 50) were randomly divided into two groups: group A (n = 50) and group B (n = 50). The patients in group A were treated with FTI combined with VisiTag to guide catheter ablation. Patients in group B were not treated with FTI combined with VisiTag. 100 patients with paroxysmal atrial fibrillation in both groups were treated with annular pulmonary vein ablation to electrical isolation of pulmonary vein. Catheter ablation of atrial fibrillation was performed under the electroanatomic mapping system (CARTO3). The time of the whole operation, the time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure were compared between the two groups. The successful rate of successful ablation of circular pulmonary vein to complete electrical isolation of pulmonary vein was successfully achieved during the operation. All the patients were closely followed up after ablation. The success rate of catheter ablation in acute (3 months) and long term AF was compared between the two groups. The incidence of complications in the two groups was analyzed. Results: in the acute observation of catheter ablation, group A was compared with group B. Not only the time of operation (107.4 鹵7.1 vs.143.2 鹵17.0 min), the time of pulmonary vein ablation to electrical isolation (35.2 鹵5.6 vs.43.5 鹵5.8min P0.05) and the time of X-ray exposure (2.0 鹵1.8 vs.4.2 鹵3.3 min P0.05) were significantly reduced, but the success rate of single ablation of pulmonary vein electrical isolation (94vs.80) was increased (P0.05). For patients with atrial fibrillation after catheter ablation, it was found that the success rate of catheter ablation in group A was significantly higher than that in group B in acute stage and long term (P 0.05, P 0.05 vs 72P, P 0.05), and the success rate of catheter ablation in group A was significantly higher than that in group B (92.0vs.76a, P0.0588vs.72p0.05). The incidence of complications in group A was significantly lower than that in group B (P0.05). Conclusion: the end point of catheter ablation for atrial fibrillation is to form effective and permanent transmural injury and to improve the long term success rate after catheter ablation. In patients with paroxysmal atrial fibrillation, FTI combined with VisiTag was used to guide catheter ablation, and when the FTI value of more than 80% of ablation points on the bilateral ablation ring was in 350g.s-450g.s, not only the whole operation time was significantly reduced. The time of pulmonary vein ablation to electrical isolation and the time of X-ray exposure increased the success rate of electric isolation from annular pulmonary vein to pulmonary vein successfully, and also increased the success rate of acute and long term after ablation. And can reduce the incidence of surgical complications. Therefore, using FTI combined with VisiTag to guide catheter ablation of paroxysmal atrial fibrillation is an effective and safe ablation strategy and has important clinical significance.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.75
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，本文編號：2196126
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