肺静脉节段性消融治疗心房颤动40例

目的初步分析肺静脉节段性消融治疗心房颤动。方法心房颤动40例，其中阵发性30例、持续性10例，年龄26～75（60±10）岁，行肺静脉节段性消融。结果达到消融终点（4根肺静脉均完全隔离）27例，完成3根肺静脉隔离9例，完成2根肺静脉隔离4例。手术操作时间（200±37）min；x线曝光时间（55±10）min。手术相关并发症9例（9／40，22．5％），其中急性心包填塞2例（2／40，5．0％）；肺静脉狭窄5例（5／40，12．5％）（其中有症状1例，无症状4例）；严重迷走神经反应2例（2／40，5．0％）。二次消融2例，手术成功，未复发。随访1～4年，总成功率为（30／40，75％）。结论经导管治疗心房颤动有效及相对安全；消融效果与左心房内径，心房颤动发作病史，是否持续性，肺静脉是否被完全隔离有关，术者通过学习曲线将能进一步提高手术成功率及降低并发症。

Clinical analysis of segmental pulmonary vein ablation in 40 patients with atrial fibrillation

Objectives To study the efficacy and safety of segmental pulmonary veins ablation （SPVA） in patients with atrial fibrillation （AF）. Methods Forty patients with paroxysmal or persistent AF were included in this study （aged 62 ± 12 years）, all the patients underwent SPVA. Results In 40 patients, 27 cases reached endpoint of ablation （4 pulmonary veins were isolated completely） , 9 cases were completed with three pulmonary veins isolation, and 4 cases were completed with two puhnonary veins isolation. Procedure time was （200±37） min and X-ray exposure time was （55±10） min. The complications occurred in 9 patients （22%）, including 2 cases （5%） with acute pericardial tamponade, 5 cases （12%） with pulmonary vein stenosis （ 1 case of symptoms, 4 cases of asymptomatic） and 2 cases （ 5% ） with serious vagal response. Two cases underwent the second ablation successfully. After follow-up of 0.8 to 4 years, total successful rate was 75%. Conclusions SPVA in patients with AF is rather effective and safety, the successful rate of ablation is related to the diameter of left atrium, the history of AF, the type of AF （ paroxysmal or persistent AF） and whether or not the pulmonary veins were isolated completely. The successful rate of ablation will be increased and the complication rate will be decreased following the study curve by operator.