心房颤动导管消融复发患者二次消融研究

目的心房颤动（房颤）导管消融治疗仍然存在一定的复发率，而其复发的特点目前仍然不清，本文对房颤消融复发患者二次消融的特点进行分析。方法共442例房颤消融治疗患者中，29例消融后复发的患者男性19例，年龄（56±11）岁]，本文患者复发时间〉6个月。对这些复发患者进行二次导管消融治疗。分析和对比初次与二次消融的电生理特点。结果29例房颤患者（20例为阵发性房颤，9例为持续性房颤）复发时间6—33（11．3±5．3）个月，所有患者初次消融后均服用3个月抗心律失常药。在复发的29例患者中，（1）3例初次消融术采用单纯靶肺静脉电隔离，二次消融发现1例出现非消融肺静脉触发灶，予以补充消融；另2例发现原靶肺静脉均有传导恢复，予以所有肺静脉经验性电隔离。（2）12例初次消融策略为所有肺静脉（48根）经验性电隔离，二次消融时发现所有患者存在不同程度的肺静脉传导恢复（36根），8例再次所有肺静脉节段电隔离（其中1例发现上腔静脉起源予以针对性电隔离）；4例患者采用三维标测系统指导下同侧肺静脉环形电隔离。（3）12例患者初次消融策略为三维标测系统指导下同侧肺静脉环形电隔离，二次消融时重复进行环肺静脉电隔离。1例患者术中发现左心房局灶性房性心动过速（房速）并成功消融，2例患者术中出现左心房不典型心房扑动（房扑）成功消融。二次消融术后随访（15±10）个月，5例患者出现房颤复发（阵发性房颤1例，持续性房颤4例；成功率82．8％），1例患者出现严重左肺静脉狭窄。结论对于房颤进行肺静脉消融电隔离治疗，其复发患者以肺静脉传导恢复为复发的主要原因。单纯进行靶肺静脉消融的部分患者，其他肺静脉的触发灶对于复发起着重要的作用。部分复发患者与非肺静脉起源的触发灶相关。复发的房颤患者，再次导管消融治疗可以达到较高的治疗成功率。

Re-ablation of the recurrent atrial fibrillation attar catheter ablation

Objectives The short-term recurrence after catheter ablation of atrial fibrillation (AF) has been well studied.However,the electrophysiological characteristics and outcome of re-ablation in recurrent patients remains unclear.Methods In 442 AF patients after catheter ablation.29 were found to be late recurreneeMale 19,age(56±11) years],which was defined as more than 6 months after the first procedure.Reablation was performed with their electrophysiological characteristics studied.Results The 29 AF patients included 20 of paroxysmal and 9 of persistent.The mean duration of late recurrence is 6～13(11.3 ±5.3)months.In these 29 cases:(1)In 3 cages,the strategy of the first ablation procedure was just the isolation of the target pulmonary vein(PV).During redo procedure non-targeted PV foci was found in one case and PV-LA conduction recovered in the rest 2 cases.(2)In 12 cases,the first procedure was the segmental isolation of all the 48 PVs.During redo,36 PVs were found to have re-conduction,and further isolation was performed,in one of which SVC was found to be foci and isolated.(3)In 12 cases,the first procedure was circumferential ipsilateral PVs isolation guided by 3-dimensional mapping system.During redo.their PV-LA conduction recovered and the same ablation strategy was repeated,with focal atrial tachycardia found in 1 and left atrial flutters in 2,which were all successfully ablated.During (15±10) months follow-up,5 of AF(82.8%) recurred with 1 of paroxysmal and 4 persistent.Severe left PV stenosis was found in one patient.Conclusions Re-ablation of the recurrent AF could have a high success rate.The recover of PV-LA conduction is minly responsible for late recurrence.For those only have target PV isolation.other PV isolation is also important.Non-PV originated foci should also be considered during ablation of the recurrent AF.