冷冻球囊消融治疗心房颤动合并心力衰竭患者临床疗效观察

周阿培; 陈东; 胡凯; 沈伟; 苏浩; 唐碧

doi:10.16766/j.cnki.issn.1674-4152.002319

冷冻球囊消融治疗心房颤动合并心力衰竭患者临床疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002319

周阿培¹,
陈东²,
胡凯³,
沈伟³,
苏浩^3, ,,
唐碧⁴

1.
蚌埠医学院研究生院2019级心血管内科，安徽蚌埠 233030
2.
合肥市第二人民医院心血管内科，安徽合肥 230012
3.
中国科学技术大学附属第一医院(安徽省立医院)心血管内科，安徽合肥 230001
4.
蚌埠医学院第一附属医院心血管内科，安徽蚌埠 233004

基金项目:

安徽省学术和技术带头人后备人选科研活动经费资助项目 2018H176

蚌埠医学院研究生科研创新计划项目 Byycx20024

详细信息

通讯作者:
苏浩，E-mail：suhaod@126.com

中图分类号: R541.61 R541.7
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-17
- 网络出版日期: 2022-03-04

Clinical effect of cryoballoon catheter ablation in patients with atrial fibrillation Combining with heart failure

ZHOU A-pei¹,
CHEN Dong²,
HU Kai³,
SHEN Wei³,
SU Hao^{3
, ,},
TANG Bi⁴

1.
Graduate School, Bengbu Medical College , Bengbu, Anhui 233030, China

摘要

摘要: 目的评价冷冻球囊消融(CCA)治疗心房颤动合并心力衰竭患者的安全性和有效性。方法回顾性分析2020年6—11月在中国科学技术大学附属第一医院诊治的3例房颤合并心衰患者，均采用CCA治疗心房颤动，观察手术的安全性。术后收集3个月和6个月的心脏超声、动态心电图、美国纽约心脏病协会(NYHA)心功能分级和N基末端B型钠尿肽(NT-proBNP)结果，观察消融治疗有效性。结果 3例患者均成功实现全部肺静脉隔离，患者1肺静脉隔离后转为心房扑动，经激动标测和拖带标测证实为三尖瓣峡部依赖典型房扑，三尖瓣峡部隔离后转为窦性心律；患者2、3肺静脉隔离后，电复律转为窦性心律，并在窦性心律下行心房电压标测，提示心房电压正常，未行基质改良；手术顺利，无并发症发生。随访6个月内，3例患者的心超参数明显改善(左室射血分数分别增加26%、32%和21%，左室舒张末内径及左房前后径较术前明显缩小)，NYHA心功能分级较术前改善1~3级，NT-proBNP均降至正常范围。患者1在6个月随访时复发，再次行消融治疗，随访6个月无房颤发生。结论冷冻球囊消融治疗房颤合并心衰是安全且有效的，可以改善心功能和心脏结构，同时可以降低NT-proBNP。
- 心房颤动 /
- 心力衰竭 /
- 冷冻球囊消融术
Abstract: Objective To evaluate the safety and efficacy of cryoballoon catheter ablation (CCA) in patients with atrial fibrillation Combining with heart failure. Methods A retrospective analysis of 3 patients with atrial fibrillation Combining with heart failure diagnosed at the First Affiliated Hospital of the University of Science and Technology of China from June 2020 to November 2020 was performed to observe the safety of CCA treatment. The results of echocardiography, dynamic electrocardiogram, cardiac function grading and N-terminal B-type natriuretic peptide (NT-proBNP) were examined after 3 and 6 months to observe the effectiveness of CCA therapy. Results All patients successfully achieved complete pulmonary vein isolation (PVI). Patient 1 converted to atrial flutter after PVI, which was proven to be typical atrial flutter and dependent on tricuspid isthmus by activation and entrainment mapping, and then turned to sinus rhythm after tricuspid isthmus isolation. Electrocardioversion of patients 2 and 3 turned to sinus rhythm following pulmonary vein isolation, and atrial voltage was mapped under sinus rhythm. All three patients had neither matrix modification nor complications. Echocardiography significantly improved (LVEF increased by 28%, 32% and 21% at 6 months post-operation, respectively; LVEDD and LAD significantly reduced), and NYHA functional class all improved to Ⅰ. The BNP of all patients reduced to the normal range. However, recurrence was found in patient 1 at 6 months follow-up. The successful CCA treatment was administered again, and no AF occurred at 6 months follow-up. Conclusion CCA for patients with atrial fibrillation Combining with heart failure is safe, which may improve cardiac function and cardiac structure and reduce NT-proBNP.
- Atrial fibrillation /
- Heart failure /
- Cryoballoon catheter ablation

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图 1 患者1术中X线影像

注：A为冷冻球囊消融左上肺静脉；B示为冷冻球囊消融左下肺静脉；C为冷冻球囊消融右上肺静脉；D为冷冻球囊消融右下肺静脉。

下载: 全尺寸图片幻灯片

图 2 患者1术中激动标测右心房

注：右心房激动标测提示顺时针旋转典型房扑。

下载: 全尺寸图片幻灯片

图 3 患者1左心耳封堵造影X线影像

注：A为左心耳造影(右前斜30°，头位20°)；B为左心耳封堵造影(右前斜32°，足位20°)。

下载: 全尺寸图片幻灯片

表 1 3例心衰患者基线资料

项目	例1	例2	例3
性别	男性	女性	男性
年龄(岁)	47	68	56
房颤类型	阵发性房颤	持续性房颤	持续性房颤
房颤病程(月)	14	2	6
心衰病因分类	扩张型心肌病	扩张型心肌病	扩张型心肌病
NYHA分级	Ⅱ	Ⅳ	Ⅲ
脑卒中	是	否	是
高血压	否	是	是
糖尿病	否	否	是
LAD(mm)	44	43	46
LVEDD(mm)	61	61	57
LVEF(%)	41	39	37
CHA2DS2-VAS评分(分)	4	6	6
HAS-BLED评分(分)	1	3	3
NT-proBNP(pg/mL)	2 250	4 908	8 010
血肌酐(μmol/L)	107.3	70.0	77.8
血清尿素氮(mmol/L)	6.3	6.2	4.3
入院时心率(次/min)	57	101	105
长期用药
ACEI	否	否	否
ARNI	是	是	是
β受体阻滞剂	是	是	否
利尿剂	是	是	是
醛固酮受体拮抗剂	是	是	是
胺碘酮	是	是	是
达比加群酯	是	是	是
注：NYHA分级为美国纽约心脏病协会心功能分级；LAD为左房前后径；LVEDD为左室舒张末内径；LVEF为左心室射血分数；CHA2DS2-VAS评分为脑卒中风险评估；HAS-BLED评分为抗凝出血风险评估；NT-proBNP为氨基末端前体B型脑钠肽；ACEI为血管紧张素转换酶抑制剂；ARNI为血管紧张素受体脑啡肽酶抑制剂。

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表 2 3例心衰患者的手术参数

项目	例1	例2	例3
手术时间(min)	132	200	135
X线曝光时间(min)	27.07	19.04	13.40
X线曝光量(mGy)	247	100	92
盐水灌注量(mL)	200	320	200
左上肺静脉
总时间t(s)	180	180	180
TTI时间(s)	15	-	28
最低温度(℃)	-43	-51	-46
左下肺静脉
总时间t(s)	180	300	180
TTI时间(s)	18	42	37
最低温度(℃)	-47	-43	-49
右上肺静脉
总时间t(s)	110	180	180
TTI时间(s)	20	38	38
最低温度(℃)	-48	-32	-47
右下肺静脉
总时间t(s)	180	180	180
TTI时间(s)	13	30	21
最低温度(℃)	-46	-47	-50
注：“-”表示无电位。TTI时间为肺静脉隔离术时间。

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表 3 3例心衰患者术后随访情况

项目	例1	例2	例3
术后3个月
NYHA分级	Ⅰ	Ⅰ	Ⅰ
LAD(mm)	44	39	40
LVEDD(mm)	52	56	55
LVEF(%)	56	67	68
NT-proBNP(pg/mL)	-	87	251
术后6个月
NYHA分级	Ⅰ	Ⅰ	Ⅰ
LAD(mm)	42	37	44
LVEDD(mm)	51	50	47
LVEF(%)	67	71	58
NT-proBNP(pg/mL)	43	45	111
注：“-”表示当时未检查。NYHA分级为美国纽约心脏病协会心功能分级；LAD为左房前后径；LVEDD为左室舒张末内径；LVEF为左心室射血分数；CHA2DS2-VAS评分为脑卒中风险评估；HAS-BLED评分为抗凝出血风险评估；NT-proBNP为氨基末端前体B型脑钠肽；ACEI为血管紧张素转换酶抑制剂；ARNI为血管紧张素受体脑啡肽酶抑制剂。

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参考文献(16)

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