| Background: Atrial fibrillation(AF) is one of the most common arrhythmia in clinical work.And with the development of the aging of the population,the prevalence rate of AF is increased significantly.At present,catheter ablation is the main treatment of AF. How to ensure the safety of the operation when improving the effectiveness of catheter ablation is a difficult problems for catheter ablation of AF.The Contact force sensing catheter like SMART TOUCH is a new type of ablation catheter,theoretically,it can improve the effectiveness and safety of radiofrequency ablation of atrial fibrillation.ST catheter tube was applied to the related research of radiofrequency ablation for AF has become the current hot.Objective: To analysis and comparison ST catheter tube and TC catheter tube in AF catheter ablation which has a high clinical ceffectiveness and safety,so that,we can chioce the surgical instruments more reasonable and make a more rational surgical project for the patients who is suffering from AF and prepare to accept catheter ablation.And,improving the success rate and safety,decreasing recurrence rate of catheter ablation.Methods: Randomized-select 34 patients who has accepted catheter ablation in People’s hospital of yuxi from January,2015 to December,2016.These patients should be PAF or PeAF with left atrial diameter (LAD) less than 40 mm and duration is less than one year.Marked as research group.Randomized-select 34 patients who has accepted catheter ablation in People’s hospital of yuxi from January,2012 to January,2015.These patients should be paroxysmal atrial fibrillation or persistent atrial fibrillation with LAD less than 40 mm and duration is less than one year.Marked as control group. The selected cases are all paroxysmal atrial fibrillation, or persistent atrial fibrillation which left atrium atrial remodeling is less unconspicuous and the course of disease is not long. So the ablation strategy of this study is just to do the bilateral pulmonary veins antrum isolation(PVI). If the PVI is completed but still not return to sinus rhythm,we will give synchronous cardioerter in vitro with energy from 100J to 200J.Or,we can consider using an intravenous infusion of Ibutilide (1 mg),which reduces the defibrillation thresholds, or use different electrical vectors. If a very few patient still unable turn to maintain sinus rhythm after treatment;and if thoese patients still seizure atrial fibrillation and flutter repeatedly, we will go to addition linear ablation such as left atrium roof lines, mitral valve narrow lines, left front wall diameter line, tricuspid spondylolysis,and complex fractionated atrial electrogram(CFAEs) ablation when necessary.The purpose of this study is to compare the time of operation、the time of ablation、left atrial modeling time、x-ray exposure、the dose of x-ray and complication rates difference between the two teams. And then,we will start a post-operation follow-up of three、six and twelve months to compare the normal sinus rhythm retention rate between two teams. So that we can provide a reliable reference for patients who is accepting radiofrequency ablation in surgical instrument selectedand operative programme.Results: 1.A11 the patients with operation were successful,and converted to sinus rhythmduring operation,and can maintain for a long time.2. All patients does not appear seriousness operative complications such as acute cardiac tamponade, steam blasting, cerebral infarction, pulmonary embolism,and even death in the process of surgery.3.There was no loss followed up .All patients have completed three times of follow-up respectively are three month、sixmonth and twelve month after operation.4. Related to observe:The research group compared with control group:4.1 The maintenance rates of sinus rhythmthree of three months after operation is had not statistical significance (94.1 %vs.91.2%, P=0.642), The maintenance rates of sinus rhythmthree of six months after operation is had not statistical significance too(88.23%vs.76.5%, P=0.203) .But the maintenance rates of sinus rhythmthree of twelve months after operation have statistically significant(88.23% vs.61.7%, P<0.05).4.2 Operation time difference have statistically significant(154.85±28.62min vs.165.88±22.17min,P>0.05) .4.3 The ablation time research group was lower than control group and the difference have statistically significant (89.71±20.41 min vs.101.62±16.82min,P<0.05) .4.4 The time of Left atrial modeling research group was lower than control group and the difference have statistically significant (8.29±2.22 min vs.10.65±2.58 min,P<0.05).4.5 The time of x-ray exposure research group was lower than control group and the difference have statistically significant (28.35±5.34min vs.39.38±6.15min).4.6 The x-ray exposure research group was lower than control group and the difference have statistically significant (417.44±80.45mGy vs.585.68±95.39mGy,P<0.05) .4.7 The reaserch group is 3 cases of complications occurred and control group is 2 cases,and the difference have no statistically significant(8.8%vs.5.9%) P=0.16).Conclusion: According to this study ,compared with TC ablation catheter,using ST ablation catheter in atrial fibrillation radiofrequency ablation will reduce time of left atrial modeling,the time of ablation,and the time of X-ray expose. Simultaneously,the reaserch gruop have a higher sinus rhythm maintenance rates of twevle month after operation.In conclusion,the contact forcing alation hane a good prospect in clinical application. |
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