Carto系统指导下环肺静脉线性消融治疗心房颤动的临床应用

目的 报道50例在Carto标测指导下环肺静脉线性消融治疗心房颤动(房颤)的结果和体会.方法 46例阵发性和4例持续性房颤患者采用Carto标测构建左心房三维电解剖图,行肺静脉造影了解其形态,围绕左侧和右侧肺静脉口线性消融,对肺静脉进行隔离.结果 50例患者均完成预定的线性消融.4例阵发性房颤患者术后1～2 d有房颤复发,l例自行转复,3例静脉用胺碘酮转复.术后1例患者出现少量心包积液,1例出现顽固性呃逆,3例出现颈部血肿.随访6～12(8.5 ±3.8)个月,37例患者未发生有症状的房颤,13例患者术后出现复发,1例患者发生肺静脉狭窄.结论 环肺静脉线性电隔离治疗房颤有较好的治疗效果,但也存在一定的并发症和复发可能性,仍需积累更多病例和做更长时间的观察.

Linear ablation and circumferential isolation of the pulmonary vein in patients with atrial fibrillation and its clinical application

Objective The aim of this study is to report the clinical results and experiences of treating 50 patients with atrial fibrillation with linear ablation and circumferential isolation of the pulmonary veins guided by Carto system.Methods Forty-six patients with paroxysmal atrial fibrillation(AF)and 4 patients with persis-tent AF received linear ablation and circumferential isolation of the left and right pulmonary veins after recon-struction of the left atrium using Carto system.Results All the designed ablation lines were accomplished in 50 patients.Four patients with paroxysmal AF recurred in 1～2days after ablation,1 patient resumed to sinus thythm by herself and others by injecting amiedarone.Small amount of pericardiac fluidity appeared in 1 pa-tient,one patient got pertinacious hiccup and blood clot wag found in the necks of 3 patients.After follow-up of 6～12(8.5±3.8)months,37 patients had no AF with clinical symptom occurred.Thirteen patients recurred sometimes,but the duration and degree of paroxysmal AF decreased siguificantly than those before RFCA.One patient occurred pulmonary vein stenosis.Conclusion Linear ablation and electrical isolation in left atrium are technically feasible and safe to treat AF but a few correlated complications may take place and AF probably recur.