房间隔缺损封堵术后合并心房颤动的房间隔穿刺及导管消融

目的先天性房间隔缺损（简称房缺）患者介入封堵术后合并的心房颤动（简称房颤）导管消融存在一定挑战,本研究拟评价这类患者房间隔穿刺及导管消融的安全性及疗效。方法共入选16例年龄（56±12）岁,10例男性]房缺封堵术后接受导管消融的房颤患者,其中阵发性房颤10例,持续性房颤6例。房间隔封堵器之外无穿刺空间者直接穿刺封堵器,在球囊扩张辅助下建立左房入路后单导管完成所有操作。阵发性房颤消融策略为环肺静脉电隔离;持续性房颤消融策略为环肺静脉电隔离联合心房线性消融并实现传导阻滞。结果 16例患者中,房间隔穿刺成功率100%,11例（A组）直接穿刺房间隔成功,5例（B组）穿刺封堵器并经球囊扩张后长鞘可顺利通过。与A组比较,B组房间隔穿刺操作时间（38±8）min vs（5±3）min]、总透视时间（54±15）min vs（31±11）min）]以及总手术时间（224±36）min vs（165±35）min）]显著延长,P均〈0.05。除B组中1例持续性房颤患者未实现二尖瓣峡部传导阻滞之外,所有患者实现既定手术终点,无严重围术期并发症发生,术后3个月复查经胸超声未见房间隔水平左向右分流。平均随访（16±6）个月,12例（75%）患者维持稳定窦性心律。结论房缺封堵术后合并的房颤经导管消融安全,有效。球囊扩张辅助下可直接穿刺房间隔封堵器获得左房入路。

Transseptal puncture and catheter ablation of atrial fibrillation with atrial septal device

Objective Catheter ablation for atrial fibrillation （AF） patients with atrial septalocclude （ASO） is chal- lenging, this study is to evaluate the feasibility and safety of catheter ablation in these patients. Methods Sixteen patients age （56 ±12）years, 10 male] with drug-refractory AF （10 paroxysmal, 6 persistent） and previously implanted ASO device underwent ablation. The transseptal puncture was performed under the guidance of RAO 45% fluoroscopy. Balloon dilation of the closure device was performed if the native septum passage could not be achieved. For paroxysmal AF, the ablation strategy was ＇circumferential pulmonary vein isolation （CPVI） and for persistent AF, atrial linear ablation was performed combined with CPVI. Results Transseptal access was achieved through the native septum in 11 patients （ group A） and through the ASO in 5 patents （ group B） with the aid of balloon dilatation. Pulmonary vein isolation was achieved in all the 16 patients and linear block was achieved in all the persistent patients except mitral isthmus block could not achieved in one patient. The transseptal, total fluoroscopy, procedural duration was （38±8） min vs （5±3）min, （54± 15） min vs （31±11） min and （224±36） rain vs （165±35） min in group B and A, respectively. No shunt at atrial level was detected by transthoracic echocarcliography at 3-month follow up. During a follow-up of （16±6） months, sinus rhythm was maintained in 12 （75%） patients. No severe complications were observed. Conclusions In patients implanted ASO, catheter ablation of AF is feasible, safe, and effective. Balloon dilatation technique can facilitate transseptal access through the ASO.