冷冻球囊消融术与射频消融术治疗心房颤动有效性和安全性的比较研究

摘要

目的：比较冷冻球囊消融术（CBA）与射频消融术（RFCA）治疗心房颤动的有效性和安全性。方法选取2013年12月—2015年5月咸阳市中心医院收治的经药物治疗失败或效果较差的心房颤动患者40例，采用随机数字表法分为 CBA 组和 RFCA 组，每组20例。CBA 组患者采用 CBA 进行治疗，RFCA 组患者采用 RFCA 进行治疗。比较两组患者左上肺静脉、右上肺静脉、左侧膈下静脉、右侧膈下静脉及左下肺静脉肺静脉隔离（ PVI）成功率、手术时间、消融时间、冷冻最低温度，术后并发症发生情况，疾病无进展生存率。结果两组患者左上肺静脉、右上肺静脉、左侧膈下静脉、右侧膈下静脉及左下肺静脉 PVI 成功率比较，差异均无统计学意义（P >0.05）；CBA 组患者左上肺静脉、左侧膈下静脉、左下肺静脉手术时间及消融时间、右上肺静脉消融时间均短于 RFCA 组，左上肺静脉、右上肺静脉、左侧膈下静脉、右侧膈下静脉冷冻最低温度均低于 RFCA 组（P <0.05）；两组患者右上肺静脉手术时间、右侧膈下静脉手术时间及消融时间、左下肺静脉冷冻最低温度比较，差异均无统计学意义（P >0.05）。RFCA 组患者术后并发症发生率为15&，CBA 组为5&，差异无统计学意义（P >0.05）。截至随访终点，CBA 组患者疾病无进展生存率为70.0&，RFCA 组为30.0&，两组患者疾病无进展生存率的 Kaplan - Meier 曲线比较，差异有统计学意义（ log- rank χ2=5.214，P =0.020）。结论 CBA 用于治疗心房颤动的 PVI 效果与 RFCA 无异，但其有利于缩短手术时间及消融时间，改善患者预后，且并未增加术后并发症发生风险，远期治疗效果较好，安全性较高。%Objective to compare the effectiveness and safety in treating atrial fibrillation between cryoballoon ablation and radiofrequency ablation. Methods A total of 40 atrial fibrillation patients with unsuccessful or poor medicine curative effect were selected in the Central Hospital of Xianyang from December 2013 to May 2015,and they were divided into CBA group and RFCA group according to random number table,each of 20 cases. Patients of CBA group were treated by cryoballoon ablation,while patients of RFCA group were treated by radiofrequency ablation. Pulmonary vein isolation rate, duration of operation and ablation,the lowest freezing temperature of left superior pulmonary vein,right superior pulmonary vein, left inferior phrenic vein,right inferior phrenic vein and left inferior pulmonary vein,incidence of postoperative complications and disease progression - free survival rate were compared between the two groups. Results No statistically significant differences of pulmonary vein isolation rate of left superior pulmonary vein,right superior pulmonary vein,left inferior phrenic vein,right inferior phrenic vein or left inferior pulmonary vein was found between the two groups( P > 0. 05);duration of operation and ablation of left superior pulmonary vein,left inferior phrenic vein and left inferior pulmonary vein,duration of ablation of right superior pulmonary vein of CBA group were statistically significantly shorter than those of RFCA group,the lowest freezing temperature of left superior pulmonary vein,right superior pulmonary vein,left inferior phrenic vein and right inferior phrenic vein of CBA group was statistically significantly lower than that of RFCA group,respectively( P > 0. 05 );no statistically significant differences of duration of operation of right superior pulmonary vein,duration of operation or ablation of right inferior phrenic vein,the lowest freezing temperature of left inferior pulmonary vein was found between the two groups(P >0. 05). the incidence of postoperative complications of CBA group was 5& ,that of RFCA group was 15& ,the difference was not statistically significantly different(P > 0. 05). till the end of follow - up,the disease progression - free survival rate of CBA group was 70. 0& ,that of RFCA was 30. 0& ,the Kaplan - Meier curve for disease progression - free survival rate between the two group was statistically significantly different( log - rank χ2 = 5. 214,P = 0. 020). Conclusion Cryoballoon ablation has similar pulmonary vein isolation effect with radiofrequency ablation in treating atrial fibrillation,but cryoballoon ablation can significantly shorten the duration of operation and ablation,improve the prognosis without increasing the risk of postoperative complications,has better long - term curative effect and relatively high safety.