2026 年第 10 期 第 21 卷

Marshall静脉无水乙醇消融联合导管射频消融治疗持续性心房颤动对术后心率变异性及心房颤动复发的影响

Effects of ethanol ablation of the vein of Marshall combined with catheter radiofrequency ablation on postoperative heart rate variability and atrial fibrillation recurrence in patients with persistent atrial fibrillation

作者：张俭1朱通建1李彬1崔胜宇1孙聪2李彩波3

英文作者：Zhang Jian1 Zhu Tongjian1 Li Bin1 Cui Shengyu1 Sun Cong2 Li Caibo3

单位：1湖北文理学院附属医院湖北省襄阳市中心医院心血管内科，襄阳441021；2湖南省怀化市中心医院心血管内科，怀化418000；3武汉科技大学医学院，武汉430065

英文单位：1Department of Cardiovascular Medicine Affiliated Hospital of Hubei University of Arts and Sciences Xiangyang Central Hospital Hubei Province Xiangyang 441021 China; 2Department of Cardiovascular Medicine Huaihua Central Hospital Hunan Province Huaihua 418000 China; 3School of Medicine Wuhan University of Science and Technology Wuhan 430065 China

关键词：Marshall静脉无水乙醇消融；持续性心房颤动；心率变异性；自主神经

英文关键词：EthanolablationoftheveinofMarshall;Persistentatrialfibrillation;Heartratevariability; Autonomicnerve

• 摘要：

• 目的  探究Marshall静脉无水乙醇消融联合导管射频消融对持续性心房颤动患者心率变异性及心房颤动复发的影响，为临床优化消融治疗策略提供循证依据。方法 采用回顾性队列研究方法，选取2023年6月至2024年6月在湖北省襄阳市中心医院首次行导管消融的持续性心房颤动患者123例，根据是否联合Marshall静脉无水乙醇消融分为EIVOM组（51例）和RF组（72例）。收集2组基线资料、手术及并发症相关指标，术后第1天及第1、3、6、12个月动态监测心率变异性核心指标［全部正常窦性NN间期标准差（SDNN）、全程窦性心搏间期平均值的标准差（SDANN）］，通过Kaplan-Meier法、Log-rank检验分析心房颤动复发情况。结果 2组环肺静脉隔离、左心房顶部线及三尖瓣峡部消融成功率均为100%。EIVOM组二尖瓣峡部阻滞率显著高于RF组［96.1%(49/51)比84.7%(61/72)］（P=0.044），且二尖瓣峡部阻滞时间显著短于RF组（P＜0.001）。与RF组相比，EIVOM组患者术后1、3、6个月的SDNN水平和术后1、3个月的SDANN水平均显著降低（均P＜0.05）。2组并发症总发生率及心包积液和腹股沟区血肿发生率比较差异均无统计学意义（均P＞0.05）。在12个月的随访期间，RF组累积无心房颤动复发生存率为75.0%，EIVOM组累积无心房颤动复发生存率为 90.2%。Log-rank检验结果表明，EIVOM组的无复发生存率显著高于RF组，差异有统计学意义（P=0.034）。结论 Marshall静脉无水乙醇消融联合导管射频消融可显著提升持续性心房颤动消融手术效果，降低术后1年心房颤动复发风险，且不增加围术期风险，其临床获益可能与该联合消融策略调控心脏自主神经功能（表现为心率变异性指标的特征性变化）相关。

• Objective To explore the effects of ethanol ablation of the vein of Marshall combined with catheter radiofrequency ablation on heart rate variability and atrial fibrillation recurrence in patients with persistent atrial fibrillation, so as to provide evidence-based basis for optimizing clinical ablation strategies. Methods A retrospective cohort study was conducted. A total of 123 patients with persistent atrial fibrillation undergoing initial catheter ablation in Xiangyang Central Hospital, Hubei Province from June 2023 to June 2024 were enrolled. Patients were divided into the EIVOM group (51 cases) and the RF group (72 cases) according to whether ethanol ablation of the vein of Marshall was performed. Baseline data, surgical parameters and complications of the two groups were collected. Core heart rate variability indicators including standard deviation of all normal-to-normal intervals (SDNN) and standard deviation of the average normal-to-normal intervals (SDANN) were dynamically monitored at postoperative day 1, 1-, 3-, 6- and 12-month follow-up. Kaplan-Meier method and Log-rank test were adopted to analyze atrial fibrillation recurrence. Results The success rates of circumferential pulmonary vein isolation, left atrial roof line ablation and tricuspid isthmus ablation were all 100% in both groups. The mitral isthmus block rate in the EIVOM group was significantly higher than that in the RF group ［96.1%(49/51) vs 84.7%(61/72)］(P=0.044), and the mitral isthmus block time was markedly shorter in the EIVOM group (P＜0.001). Compared with the RF group, the EIVOM group presented significantly decreased SDNN at 1, 3 and 6 months after operation, as well as decreased SDANN at 1 and 3 months after operation (all P＜0.05). There were no significant differences in the total incidence of complications, pericardial effusion and inguinal hematoma between the two groups (all P＞0.05). During the 12-month follow-up, the cumulative atrial fibrillation-free survival rate was 75.0% in the RF group and 90.2% in the EIVOM group. Log-rank test demonstrated that the recurrence-free survival rate was significantly higher in the EIVOM group (P=0.034). Conclusion Ethanol ablation of the vein of Marshall combined with catheter radiofrequency ablation can significantly improve the ablation efficacy for persistent atrial fibrillation and reduce the 1-year postoperative recurrence risk of atrial fibrillation without increasing perioperative risks. Its clinical benefit may be related to the regulation of cardiac autonomic nervous function reflected by characteristic changes in heart rate variability indicators.