经导管消融治疗心房颤动的复发原因分析

目的 对经导管消融治疗心房颤动(房颤)的复发患者进行电生理检查和重复消融术,探讨房颤远期复发(消融术后≤1年)、更远期复发(消融术后＞1年)和二次消融术后复发的原因.方法 2001年1月至2005年12月共完成经导管消融治疗房颤患者234例,其中节段性肺静脉电隔离术(SPVI)156例,环肺静脉消融术(CAPV)78例.随访时间为18～90(54±24)个月.对消融术后复发的患者进行重复消融术,通过心腔内电生理检查明确复发的原因.结果 75例患者出现远期复发,其中58例(77.3%)肺静脉-左心房(PV-LA)电连接恢复,17例(22.7%)存在肺静脉外的异位兴奋灶共28处;17例患者出现更远期复发,其中4例(23.5%)为PV-LA电连接恢复,13例(76.5%)存在肺静脉外的异位兴奋灶21处;对上述患者行二次消融后,有43例患者再次复发,腔内电生理检查提示8例(18.6%)为PV-LA电连接恢复,35例(81.4%)存在肺静脉外的异位兴奋灶共47处.非肺静脉异位兴奋灶的分布依次是左心房后壁、冠状静脉窦口部(CSO)、界嵴(crista terminalis,CT)、上腔静脉(SVC)口部、下腔静脉(IVC)口部、右心房游离壁.结论 经导管消融术治疗房颤后远期复发的主要原因是肺静脉电连接恢复,更远期复发和二次消融术后复发的主要原因是肺静脉以外存在异位兴奋灶,重视心房特殊结构标测和消融可以提高治疗成功率.

The different mechanisms of recurrence of atrial fibrillation after radiofrequency catheter ablation

Objective To investigate the different mechanisms of late(≤1 year after ablation),verylate recurrence(＞1 year after ablation)and recurrence of atrial fibrillation(AF)after repeat ablation.Methods From January 1,2001 to December 30,2005,234 patients with AF accepted radiofrequency catheter ablation(RFCA)in which 156 patients accepted segmental pulmonary vein isolation(SPVI)and 78 patients accepted circumferential ablation of pulmonary vein(CAPV).The follow-up time was 18～90(54±24) months.All patients with recurrence accepted repeat ablation and intra-cardiac eleetrophysiologic study to determine the mechanisms of recurrence.Results Late recurrence occurred in 75 patients.Among them,recovery of PV-LA conduction was found in 58(77.3%)patients,28 non-PV ectopic focus were found in 17(22.7%)patients.Very late recurrence was found in 17 patients.Among them.recovery of PV-LA conduction was found in 4(23.5%)patients,21 non-PV ectopic focus were found in 13(76.5%)patients.Forty-three patients who accepted repeat ablation suffered from recurrence again and accepted third ablation procedure.During the third ablation,recovery of PV-LA conduction was found in 8(18.6%)patients,47 non-PV eetopic focus were found in 35(81.4%)patients.Non-PV ectopic focus were commonly seen in posterior wall of left atrial wall,CSO,CT,SVC,IVC and free wall of right atrium.Condusions After radiofrequency catheter ablation of AF,the main reason of late recurrence is recovery of PV-LA conduction,the main mechanism of very late recurrence and recurrence after repeat ablation procedure is non-PV ectopic foci.