金吴珍,江晶晶,黄克强,李希,唐成

• 1:武汉亚心总医院心内科

摘要(Abstract)：

目的 在高功率及常规功率模式下进行阵发性心房颤动（房颤）导管消融，术中即刻通过食管镜检查评估食管热损伤。方法 入选2021年1月至2022年5月于武汉亚心总医院诊断为阵发性房颤并接受导管消融的患者。按照消融功率将患者分为高功率组（消融功率45 W,43℃）及常规功率组（消融功率35 W,43℃），术中两组患者均完成双侧肺静脉隔离。完成消融后，术中通过专业的消化科医师，即刻给予食管镜检查，并评估两组患者食管热损伤程度。结果 共入选75例阵发性房颤患者，高功率组（41例），常规功率组（34例），两组患者术中肺静脉隔离成功率100%，两组患者完成肺静脉隔离后，即刻进行食管镜检查。高功率组有4例（9.8%）出现食管热损伤，其中3例食管黏膜红斑，1例食管血疱（患者术中接受钛夹治疗，1个月后复查食管镜，病变部位愈合良好）；常规功率组有12例（35.3%）出现食管热损伤，9例食管黏膜红斑，3例食管血疱（3例患者术中均接受钛夹治疗，1个月后复查食管镜，病变部位均愈合良好）。两组患者出现食管热损伤发生率比较，差异有统计学意义（P=0.007）。术后1年随访，高功率组房颤消融术成功率为85.4%，有6例患者术后复发，其中3例阵发性房颤、1例阵发性心房扑动、2例阵发性房性心动过速；常规功率组房颤消融术成功率为85.3%,5例患者术后复发，其中4例阵发性房颤、1例阵发性房性心动过速。两组患者术后1年房颤消融术成功率比较，差异无统计学意义（P=0.417）。结论 术中运用高功率模式进行肺静脉隔离较常规功率模式可减少食管热损伤。术中可选择即刻行食管镜检查，以便更早地发现食管热损伤，并及时给予治疗，减少左心房食管瘘的风险，进一步提高房颤导管消融的安全性。

关键词(KeyWords)： 心房颤动;导管消融;食管热损伤;左心房食管瘘

Abstract:

Keywords:

基金项目(Foundation): 武汉市医学科研项目（WX21C10）

作者(Author): 金吴珍,江晶晶,黄克强,李希,唐成

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