刘广安,吴王龙,周凛潇,崔婧,邵波,张若溪,刘峰

• 1:上海交通大学医学院苏州九龙医院心内科

摘要(Abstract)：

目的 评价高功率短时程射频导管消融治疗持续性心房颤动（房颤）的有效性和安全性。方法 本研究回顾性纳入了2019年1月至2023年12月上海交通大学医学院苏州九龙医院诊断为持续性房颤并首次接受导管射频消融术患者392例，其中应用高功率短时程组256例，低功率长时程组136例，分别统计消融时间、总手术时间、肺静脉单圈隔离率、即刻手术成功率、消融点数和围术期并发症（包括心脏压塞、假性动脉瘤、动静脉瘘、脑卒中等），术后第3、6和12个月随访并统计12个月窦性心律维持率。结果 高功率短时程组的消融时间[（14.6±2.3）min比（30.3±4.2）min,P<0.001]和总手术时间[（113.8±24.8）min比（128.5±26.7）min,P=0.001]比低功率长时程组明显减少；肺静脉单圈隔离率（97.7%比94.9%,P=0.823）、消融点数量[（71.2±8.0）个比（74.3±14.3）个，P=0.168]和围术期并发症发生率（3.1%比4.4%,P=0.571）两组比较，差异均无统计学意义；术后12个月窦性心律维持率方面，高功率短时程组高于低功率长时程组，但差异无统计学意义（82.8%比79.4%,P=0.399）。结论 高功率短时程导管射频消融术可提高持续性房颤的手术效率，其有效性和安全性与低功率长时程消融相似。

关键词(KeyWords)： 持续性心房颤动;射频消融术;高功率;短时程

Abstract:

Keywords:

基金项目(Foundation): 苏州市卫生局科技项目（LCZX201321）

作者(Author): 刘广安,吴王龙,周凛潇,崔婧,邵波,张若溪,刘峰

参考文献(References)：

• [1]Joglar JA,Chung MK,Armbruster AL,et al.2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].J Am Coll Cardiol,2024,83(1):109-279.DOI:10.1016/j.jacc.2023.08,017.
• [2]Winkle RA,Mead RH,Engel G,et al.Very long term outcomes of atrial fibrillation ablation[J].Heart Rhythm,2023,20(5):680-688.DOI:10.1016/j.hrthm.2023.02.002.
• [3]Choi SH,Yu HT,Kim D,et al.Late recurrence of atrial fibrillation 5 years after catheter ablation:predictors and outcome[J].Europace,2023,25(5):euad113.DOI:10.1093/europace/euad 113.
• [4]Ma C,Yin X,Xia Y,et al.High-power,short-duration ablation in the coronary sinus:clinical cases and preliminary observations on swine hearts[J].J Interv Card Electrophysiol,2022,63(2):311-321.DOI:10.1007/s10840-021-00994-0.
• [5]Osorio J,Hussein AA,Delaughter MC,et al.Very high-power sho rt-duration,temperature-controlled radiofrequency ablation in paroxysmal atrial fibrillation:the prospective multicenter Q-FFICIENCY trial[J].JACC Clin Electrophysiol,2023,9(4):468-480.DOI:10.1016/j.jacep.2022.10.019.
• [6]Knotts RJ,Barbhaiya CR.High-power,short-duration ablation for atrial fibrillation:pros and cons[J].Prog Cardiovasc Dis,2021,66:86-91.DOI:10.1016/j.pcad.2021.06.005.
• [7]Tzeis S,Gerstenfeld EP,Kalman J,et al.2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation[J].Europace,2024,26(4):euae043.DOI:10,1093/europace/euae043.
• [8]Park CI,Lehrmann H,Keyl C,et al.Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation:the deterministic role of contact force and interlesion distance[J].J Cardiovasc Electrophysiol,2014,25(7):701-708.DOI:10.1111/jce.12396.
• [9]Reddy VY,Shah D,Kautzner J,et al.The relationshipbetween contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study[J].Heart Rhythm,2012,9(11):1789-1795.DOI:10.1016/j.hrthm.2012.07.016.
• [10]Buist TJ,Zipes DP,Elvan A.Atrial fibrillation ablation strategies and technologies:past,present,and future[J].Clin Res Cardiol,2021,110(6):775-788.DOI:10.1007/s00392-020-01751-5.
• [11]李康,丁燕生.2023年美国心房颤动指南解读——心房颤动导管消融[J].中国介入心脏病学杂志,2024,32(3):164-167.DOI:10.3969/j.issn.1004-8812.2024.03.007.
• [12]杨新春,左琨.《2020年欧洲心脏病学会心房颤动管理指南》解读[J].中国介入心脏病学杂志,2020,28(10):541-546.DOI:10.3969/j.issn.1004-8812.2020.10.001.
• [13]Bourier F,Duchateau J,Vlachos K,et al.High-power shortduration versus standard radiofrequency ablation:insights on lesion metrics[J].J Cardiovasc Electrophysiol,2018,29(11):1570-1575.DOI:10.1111/jce.13724.
• [14]尹磊,张媛媛,何长健,等.心房颤动高功率短时程消融的应用研究进展[J].中国介入心脏病学杂志,2022,30(6):458-461.DOI:10.3969/j.issn.1004-8812.2022.06.013.
• [15]Naniwadekar A,Dukkipati SR.High-power short-duration ablation of atrial fibrillation:a contemporary review[J].Pacing Clin Electrophysiol,2021,44(3):528-540.DOI:10.1111/pace.14167.
• [16]蔡衡,郑红梅,李洪仕,等.高功率短时程射频消融治疗心房颤动安全性和有效性评价[J].中华心律失常学杂志,2019,23(6):485-491.DOI:10.3760/cma.j.issn 1007-6638.2019.06.003.
• [17]Kewcharoen J,Techorueangwiwat C,Kanitsoraphan C,et al.High-power short duration and low-power long duration in atrial fibrillation ablation:a meta-analysis[J].J Cardiovasc Electrophysiol,2021,32(1):71-82.DOI:10.1111/jce.14806.
• [18]Yavin HD,Leshem E,Shapira-Daniels A,et al.Impact of high-power short-duration radiofrequency ablation on longterm lesion durability for atrial fibrillation ablation[J].JACC Clin Electrophysiol,2020,6(8):973-985.DOI:10.1016/j.jacep.2020.04.023.