张坤,孙光瑶,白金龙,王沛泽,方丕华

• 1:泰达国际心血管病医院心内科

摘要(Abstract)：

目的 分析心房颤动（房颤）使用二代冷冻球囊消融时影响右下肺静脉消融难易程度的因素。方法 回顾性分析2019年6月至2022年3月在泰达国际心血管病医院首次使用二代冷冻球囊消融治疗房颤的患者234例，所有患者术前均已完善左心房CT血管造影（CTA）检查，收集其肺静脉内径（长径、短径）、内径比、测量右下肺静脉角度（下向角度、后向角度）、肺间距、开口高度、早分支情况等，根据右下肺静脉冷冻次数是否≥3次，分为容易组和困难组。结果 纳入234例患者，年龄（62.8±8.1）岁，女性87例（37.2%），阵发性房颤164例（70.1%），困难组56例，容易组178例。所有患者均实现肺静脉隔离，容易组患者右下肺静脉冷冻的最低温度更低[（–48.0±6.2）℃比（–44.6±6.5）℃，P<0.001）]，肺静脉电位实时记录率更高（49.4%比33.9%,P=0.042）；困难组患者，早期病例（2019年度病例）的比例更高（46.4%比19.7%,P <0.001）；容易组与困难组患者右下肺静脉下向成角差异有统计学意义[（59.5±12.3）°比（65.1±14.6）°，P=0.005]；内径、内径比、两肺间距、开口高度、后向成角、早分支等差异均无统计学意义（均P>0.05）。纳入上述解剖因素和是否早期病例进行Logistic回归分析，下向成角和早期病例是影响肺静脉消融难易程度的独立危险因素（OR 0.968,95%CI 0.943～0.993,P=0.013;OR 0.285,95%CI 0.143～0.565,P=0.001）。受试者工作特征曲线显示，使用下向成角预测右下肺静脉封堵困难的曲线下面积0.745(95%CI 0.668～0.822,P<0.001)，最佳截断值63.5°，敏感度67.9%，特异度71.9%。结论 在冷冻消融术中，右下肺静脉的下向成角和术者的手术熟练度是影响手术难易程度的主要因素。

关键词(KeyWords)： 心房颤动;冷冻消融;解剖

Abstract:

Keywords:

基金项目(Foundation): 天津市医学重点学科（专科）建设项目（TJYXZDXK-020A）

作者(Author): 张坤,孙光瑶,白金龙,王沛泽,方丕华

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