在肺静脉隔离中对麻醉方式的比较分析:来自潜在的多中心注册表的见解
Eias Massalha1,2, Amer Dakka1,2, Avi Sabbag1,2
1Heart Institute, Sheba Medical Center, Tel-Hashomer, Derech Sheba 2, 5262000 Ramat Gan, Israel.
概括
意识镇静 (CS) 和通用麻醉 (GA) 一样安全和有效,用于心房动 (AF) 导管切除 (CA),特别是冷却气球切除 (CBA). 患者和机构因素,而不是麻醉类型,影响长期AF复发和并发症率.
科学领域:
- 心脏病学 心脏病学
- 麻醉学 麻醉学
背景情况:
- 在全球范围内,心房动 (AF) 的患病率正在上升,这使得导管切除 (CA),特别是肺静脉隔离 (PVI),成为关键的治疗方法.
- 对于PVI,存在各种能量来源 (冷却气球除,射频除,脉冲场除) 和麻醉方式 (全身麻醉,深度镇静,意识镇静).
- 由于之前的研究结果相互矛盾,PVI的最佳麻醉仍然不清楚.
研究的目的:
- 为了比较不同麻醉方式的安全性和有效性,用于肺静脉隔离 (PVI) 在心房 (AF) 患者.
- 评估麻醉选择对手术结果的影响,包括AF复发和并发症.
- 评估是否有意识的镇静 (CS) 是PVI的全身麻醉 (GA) 的可行的替代方案.
主要方法:
- 一项前性多中心研究分析了2019年1月至2021年12月期间接受PVI的1002名患者的数据.
- 通过麻醉来分层患者:CS与GA (包括深度镇静).
- 包括AF复发,并发症和成功率在内的结果在24个月内进行了评估,对冷却气球移除 (CBA) 亚组进行了敏感性分析.
主要成果:
- 在91%的患者中实现了完整的PVI,CS和GA组之间的成功率相似.
- 在12个月 (15%对16%) 和24个月 (19.5%对21.2%) 的AF复发率中,在CS和GA之间没有发现显著差异.
- 对CBA亚组的敏感性分析也显示,CS和GA之间的AF复发,并发症或程序持续时间没有显著差异.
结论:
- 意识镇静 (CS) 的安全性和疗效与通用麻醉 (GA) 对心房动 (AF) 导管切除 (CA) 的安全性和疗效相当,特别是在使用冷气球切除 (CBA) 时.
- 麻醉方式的选择受患者特征和机构实践的影响,而不是影响AF复发率或并发症率等长期结果.
- 这表明CS可以成为PVI程序中GA的安全和有效替代品.
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