摘要目的 回顾性分析应用第二代冷冻球囊消融电隔离肺静脉发生交互效应(当上肺静脉未能被电隔离,在冷冻消融并电隔离同侧下肺静脉的同时,上肺静脉也出现了电隔离效应)的电生理和肺静脉-左心房解剖特性,以期为更好地利用该技术提供依据.方法 2016年8月至2017年12月,于阜外医院首次行第二代冷冻球囊消融治疗的阵发性心房颤动患者共504例.选取首次180 s冷冻结束时未达到左上或右上肺静脉电隔离的患者89例,其中35例发生了交互效应,纳入交互效应组,余54例患者为对照组.比较交互效应组与对照组基线资料、术中肺静脉电位变化情况、肺静脉冷冻消融时间和次数以及肺静脉-左心房的解剖特征.结果 交互效应组中,33例(33/35,94.3％)患者左上肺静脉发生交互效应.交互效应组中所有患者在上肺静脉冷冻消融过程中均出现肺静脉电位延迟,而对照组有39例(39/54,72.2％)电位延迟,差异有统计学意义(P＜0.05).左侧发生交互效应的33例,其左上肺冷冻消融时间短于对照组[(281.1±103.1)s对(335.2±85.6)s,P＜0.05],冷冻消融次数少于对照组[(1.85±0.86)次对(2.12±0.65)次,P＜0.05].交互效应组左侧上、下肺静脉间平均距离短于对照组[(6.12±1.19)mm对(7.63±1.39) mm,P＜0.05],右侧上、下肺静脉间平均距离亦短于对照组[(6.25±0.21)mm对(8.44±1.58)mm,P＜0.05];左侧上、下肺静脉间平均距离短于右侧上、下肺静脉间平均距离[(6.68±1.45)mm对(8.32±1.61) mm,P＜0.05].结论 左侧肺静脉发生交互效应的比例明显高于右侧肺静脉,肺静脉电位延迟是发生交互效应的前提,上、下肺静脉较短的间距对于发生交互效应有一定的预测价值.

abstractsObjective We aimed to explore the electrophysiological and left atrial anatomical characteristics of pulmonary vein isolation (PVI) with the "crosstalk" technique during second-generation cryoballon ablation and figure out a better practice of this technique.Methods A total of 504 patients with atrial fibrillationwere included.All of these patients underwent initial ablation with second-generation cryoballoon.Among these patients,89 patients (17.7％) did not achieve left/right superior pulmonary vein (LSPV/RSPV) isolation during first cryoablation.In the study group,there were 35 (39.3％) patients had "crosstalk" phenomenon.The remaining 54 patients (60.7％) without "crosstalk" were included in the control group.The baseline data,electrophysiological and anatomic characteristics of left atrium were compared between study group and control group.Results In the "crosstalk" group,33 patients (94.3％) had "crosstalk" phenomenon in the LSPV.All of the patients (100％) had pulmonary vein potentials (PVP) delay during first cryoablation in the "crosstalk" group.Otherwise,PVP delays were observed in only 39 patients (72.2％) in the control group (P＜0.05).The total ablation time [(281.1 ± 103.1) s vs.(335.2:± 85.56) s,P＜0.05] and frequency [(1.85 ± 0.86) times vs.(2.12 ± 0.65) times,P＜ 0.05] were different between these two groups.As for the anatomic characteristics,the average distance from LSPV to inferior pulmonary vein was shorter in the "crosstalk" group [(6.12 ± 1.19)mm vs.(7.6 ± 1.39) mm,P＜0.05].Similarly,the average distance of RSPV and inferior pulmonary veins was also shorter in study group [(6.25 ± 0.21) mm vs.(8.44 ± 1.58) mm,P＜ 0.05].Conclusion The "crosstalk" phenomenon was more frequent in the left pulmonary vein.Short distance between superior and inferior pulmonary vein and PVP delay during ablation could predict the "crosstalk" phenomenon.