不同類型心房顫動(dòng)患者三尖瓣峽部傳導(dǎo)時(shí)間的比較
發(fā)布時(shí)間：2018-07-27 21:10
【摘要】：目的:心房顫動(dòng)(atrial fibrillation,AF,簡(jiǎn)稱房顫)是臨床上最常見的心律失常,給患者生活質(zhì)量帶來嚴(yán)重影響。房顫的導(dǎo)管射頻消融已成為藥物難治性房顫患者的主要治療方式。對(duì)于持續(xù)性心房顫動(dòng),目前國(guó)內(nèi)外指南皆推薦需要在雙側(cè)環(huán)肺靜脈消融基礎(chǔ)上進(jìn)行心房基質(zhì)改良,包括左心房頂部線消融、二尖瓣峽部消融或三尖瓣峽部消融等。然而近期研究發(fā)現(xiàn)額外消融不能增加手術(shù)成功率,且額外增加手術(shù)時(shí)間及風(fēng)險(xiǎn)。因此慢性房顫是否需要就行三尖瓣線性消融目前沒有標(biāo)準(zhǔn)。本研究旨在研究不同類型心房顫患者三尖瓣峽部傳導(dǎo)時(shí)間特點(diǎn),探討其對(duì)房顫導(dǎo)管消融的指導(dǎo)意義。方法:選取2015年12月至2016年10月于大連醫(yī)科大學(xué)附屬第一醫(yī)院及大連大學(xué)附屬中山醫(yī)院通過導(dǎo)管射頻消融術(shù)(RFCA)進(jìn)行節(jié)律控制的陣發(fā)性室上速、預(yù)激綜合征、陣發(fā)性房顫、持續(xù)性房顫或合并典型房撲的患者。排除合并甲狀腺功能亢進(jìn)癥,心房?jī)?nèi)血栓,嚴(yán)重肝腎功能不全,心臟瓣膜中度以上狹窄或關(guān)閉不全所致房顫,多次射頻消融術(shù)后患者,心房疤痕較多及外科三尖瓣置換及消融術(shù)后患者。將其分為對(duì)照組(normal)(陣發(fā)性室上速和預(yù)激綜合征患者),AF組包括陣發(fā)性房顫亞組(paAF)及持續(xù)性房顫亞(peAF)組。以600ms的頻率起搏冠狀竇近端,起搏狀態(tài)下消融電極標(biāo)測(cè)三尖瓣環(huán),記錄起搏狀態(tài)下三尖瓣環(huán)各點(diǎn)激動(dòng)時(shí)間,X線左前斜(LA045°)5:30到7:30鐘的激動(dòng)時(shí)間為三尖瓣環(huán)峽部傳導(dǎo)時(shí)間(cavotricuspid isthmus conduction time,ICT)。并計(jì)算三尖瓣環(huán)峽部傳導(dǎo)時(shí)間與三尖瓣環(huán)傳導(dǎo)時(shí)間(tricuspid valve annulus conduction time,TCT)比值。TCT=(Tmax-Tmin)×2,即最大值與最小值差值的兩倍為TCT。三尖瓣環(huán)峽部傳導(dǎo)時(shí)間比例(cavotricuspid isthmus conduction time Proportion,ICP)為峽部傳導(dǎo)時(shí)間與三尖瓣環(huán)時(shí)間的比值,ICP =ICT/TCT。結(jié)果:1.三組間基線資料比較:normal組與paAF組、peAF組總體比較還是兩組內(nèi)亞組間分別比較,基線資料如性別、年齡、高血壓、糖尿病均無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。2.三組間 TCT 比較:TCT 分別為 normal 組(68.47 ±21.3)、paAF(63.74±19.23)、peAF(87.48±17.68)。與normal組相比,AF組與正常對(duì)照組相比TCT增長(zhǎng)(P0.05),而paAF組與正常對(duì)照組則無(wú)明顯改變(P=0.153)。在AF組中peAF亞組明顯長(zhǎng)于paAF組(P0.05))。3.三組間 ICT 比較:ICT 分別為 normal 組(23.31 ± 17.61)、paAF(26.17±19.43)、peAF(53.26 ±21.90)。與 normal 組相比,AF 組 ICT 延長(zhǎng)(P0.05),且peAF組與normal組相比傳導(dǎo)速度明顯減慢(P0.05)。在AF組中,paAF組長(zhǎng)于paAF組(P0.05)。4.三組間 ICP 比較:ICP 分別為 normal 組(0.194 ± 0.0642)paAF 組(0.267±0.0771)peAF組(0.372 ±0.0712)。AF 組與 normal 組相比 ICP 明顯增大(P0.05),peAF組與正常對(duì)照組組相比明顯增大(P0.05)。在AF組中,peAF 組大于 paAF 組(P0.05)。結(jié)論:1.AF組患者其TCT、ICT均長(zhǎng)于normal組患者,且peAF組患者更長(zhǎng),提示房顫可使心房重構(gòu),導(dǎo)致三尖瓣及三尖瓣峽部傳導(dǎo)時(shí)間均延長(zhǎng)。2.AF組患者其ICP均大于normal組患者,且peAF組患者更大,提示房顫導(dǎo)致三尖瓣環(huán)傳導(dǎo)時(shí)間延長(zhǎng)以三尖瓣環(huán)峽部傳導(dǎo)時(shí)間延長(zhǎng)為主。3.提示房顫患者三尖瓣環(huán)傳導(dǎo)時(shí)間延長(zhǎng),特別三尖瓣環(huán)峽部傳導(dǎo)時(shí)間延長(zhǎng),消融術(shù)中進(jìn)行峽部干預(yù)可能是必需的。
[Abstract]:Objective: atrial fibrillation (AF) is the most common arrhythmia in clinic, which has a serious effect on the quality of life in patients. Catheter radiofrequency ablation of atrial fibrillation has become the main treatment for patients with refractory atrial fibrillation. For persistent atrial fibrillation, both domestic and foreign guidelines are currently recommended for bilateral CF. Amelioration of atrial matrix on the basis of venous ablation, including left atrio roof line ablation, mitral isthmus ablation, or three apical isthmus ablation. However, recent studies have found that extra ablation does not increase the success rate of the operation and increases the operation time and risk. Therefore, there is no need for three tip linear ablation for chronic atrial fibrillation. The purpose of this study was to study the characteristics of the three apical isthmus conduction time in patients with different types of atrial fibrillation and to explore the guiding significance of the catheter ablation of atrial fibrillation. Methods: the rhythmic control was carried out by catheter radiofrequency ablation (RFCA) in the First Affiliated Hospital of Dalian Medical University and the affiliated Zhongshan Hospital Affiliated to Dalian University from December 2015 to October 2016. Paroxysmal supraventricular tachycardia, preexcitation syndrome, paroxysmal atrial fibrillation, persistent atrial fibrillation, or typical atrial flutter. Excluding hyperthyroidism, atrial thrombus, severe liver and kidney insufficiency, atrial fibrillation caused by moderate or above stenosis or insufficiency of the heart valve, patients after multiple radiofrequency ablation, more atrial scars and surgical three tips The patients were divided into control group (normal) (paroxysmal supraventricular tachycardia and preexcitation syndrome), group AF including paroxysmal atrial fibrillation (paAF) and persistent atrial fibrillation (peAF) group. At the frequency of 600ms, the near end of the coronary sinus was paced at the frequency of 600ms, and the ablation electrode was used to measure the three apical rings under the pacing state, and the points of the three apex rings at the pacing state were recorded. Excitant time, the exciting time of the X-ray left anterior oblique (LA045) from 5:30 to 7:30 am the three apical annular isthmus conduction time (cavotricuspid isthmus conduction time, ICT), and calculated the ratio of the conduction time of the three apical annular isthmus to the three apical ring conduction time (tricuspid valve annulus conduction time, TCT), which is the maximum and the minimum. The two times of the value difference was the ratio of the TCT. three apical annular isthmus conduction time (cavotricuspid isthmus conduction time Proportion, ICP) as the ratio of the isthmus conduction time to the three apical ring time, ICP =ICT/TCT. results: the comparison of the baseline data between the 1. three groups: the normal group and the paAF group, the general comparison of the peAF group or the two group of the inner subgroups, respectively, the baseline. The data such as sex, age, hypertension and diabetes were not significantly different (P0.05).2. three group TCT comparison: TCT was normal (68.47 + 21.3), paAF (63.74 + 19.23), peAF (87.48 + 17.68). Compared with the normal group, the AF group was longer than the normal control group (P0.05), but there was no significant change in the paAF group and the normal control group. In group AF, peAF subgroup was significantly longer than group paAF (P0.05) in.3. three groups, ICT compared: ICT was normal group (23.31 + 17.61), paAF (26.17 + 19.43), peAF (53.26 + 21.90). ICP comparison between the three groups: ICP was normal (0.194 + 0.0642) paAF group (0.267 + 0.0771) peAF group (0.372 + 0.0712).AF group and normal group compared with normal group, ICP increased significantly (P0.05), peAF group was significantly higher than normal control group (P0.05). Patients in group rmal, and group peAF were longer, suggesting atrial fibrillation can cause atrial remodeling, leading to three apical valves and three apical isthmus conduction time extended in group.2.AF, and the ICP in group normal was greater than that in group normal, and the patients in group peAF were larger, suggesting that atrial fibrillation leads to prolonged three apical ring conduction time with prolonged three apical isthmus conduction time prolonging.3. prompting atrial fibrillation. The extension of the three cusp ring conduction time, especially the extension of the isthmus of the three ring annulus, may be necessary for the isthmus intervention during ablation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75
，
本文編號(hào)：2149145
[Abstract]:Objective: atrial fibrillation (AF) is the most common arrhythmia in clinic, which has a serious effect on the quality of life in patients. Catheter radiofrequency ablation of atrial fibrillation has become the main treatment for patients with refractory atrial fibrillation. For persistent atrial fibrillation, both domestic and foreign guidelines are currently recommended for bilateral CF. Amelioration of atrial matrix on the basis of venous ablation, including left atrio roof line ablation, mitral isthmus ablation, or three apical isthmus ablation. However, recent studies have found that extra ablation does not increase the success rate of the operation and increases the operation time and risk. Therefore, there is no need for three tip linear ablation for chronic atrial fibrillation. The purpose of this study was to study the characteristics of the three apical isthmus conduction time in patients with different types of atrial fibrillation and to explore the guiding significance of the catheter ablation of atrial fibrillation. Methods: the rhythmic control was carried out by catheter radiofrequency ablation (RFCA) in the First Affiliated Hospital of Dalian Medical University and the affiliated Zhongshan Hospital Affiliated to Dalian University from December 2015 to October 2016. Paroxysmal supraventricular tachycardia, preexcitation syndrome, paroxysmal atrial fibrillation, persistent atrial fibrillation, or typical atrial flutter. Excluding hyperthyroidism, atrial thrombus, severe liver and kidney insufficiency, atrial fibrillation caused by moderate or above stenosis or insufficiency of the heart valve, patients after multiple radiofrequency ablation, more atrial scars and surgical three tips The patients were divided into control group (normal) (paroxysmal supraventricular tachycardia and preexcitation syndrome), group AF including paroxysmal atrial fibrillation (paAF) and persistent atrial fibrillation (peAF) group. At the frequency of 600ms, the near end of the coronary sinus was paced at the frequency of 600ms, and the ablation electrode was used to measure the three apical rings under the pacing state, and the points of the three apex rings at the pacing state were recorded. Excitant time, the exciting time of the X-ray left anterior oblique (LA045) from 5:30 to 7:30 am the three apical annular isthmus conduction time (cavotricuspid isthmus conduction time, ICT), and calculated the ratio of the conduction time of the three apical annular isthmus to the three apical ring conduction time (tricuspid valve annulus conduction time, TCT), which is the maximum and the minimum. The two times of the value difference was the ratio of the TCT. three apical annular isthmus conduction time (cavotricuspid isthmus conduction time Proportion, ICP) as the ratio of the isthmus conduction time to the three apical ring time, ICP =ICT/TCT. results: the comparison of the baseline data between the 1. three groups: the normal group and the paAF group, the general comparison of the peAF group or the two group of the inner subgroups, respectively, the baseline. The data such as sex, age, hypertension and diabetes were not significantly different (P0.05).2. three group TCT comparison: TCT was normal (68.47 + 21.3), paAF (63.74 + 19.23), peAF (87.48 + 17.68). Compared with the normal group, the AF group was longer than the normal control group (P0.05), but there was no significant change in the paAF group and the normal control group. In group AF, peAF subgroup was significantly longer than group paAF (P0.05) in.3. three groups, ICT compared: ICT was normal group (23.31 + 17.61), paAF (26.17 + 19.43), peAF (53.26 + 21.90). ICP comparison between the three groups: ICP was normal (0.194 + 0.0642) paAF group (0.267 + 0.0771) peAF group (0.372 + 0.0712).AF group and normal group compared with normal group, ICP increased significantly (P0.05), peAF group was significantly higher than normal control group (P0.05). Patients in group rmal, and group peAF were longer, suggesting atrial fibrillation can cause atrial remodeling, leading to three apical valves and three apical isthmus conduction time extended in group.2.AF, and the ICP in group normal was greater than that in group normal, and the patients in group peAF were larger, suggesting that atrial fibrillation leads to prolonged three apical ring conduction time with prolonged three apical isthmus conduction time prolonging.3. prompting atrial fibrillation. The extension of the three cusp ring conduction time, especially the extension of the isthmus of the three ring annulus, may be necessary for the isthmus intervention during ablation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75
，
本文編號(hào)：2149145
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