冷冻消融治疗心房扑动和颤动的初步临床应用

报道应用冷冻导管消融His束和消融右房峡部、隔离肺静脉治疗阵发性心房扑动(简称房扑 )合并心房颤动(简称房颤)各 1例。例 1男性, 79岁,因反复心悸伴晕厥入院。心电图示阵发房颤伴快速心室率 190~220次 /分,药物治疗效果差,决定用冷冻导管消融His束。先进行冷冻标测,温度 -30℃,持续时间 <80s,确定靶点后 ( -30℃,冷冻标测 50s,出现房室阻滞,复温后恢复正常传导)开始冷冻消融,温度降至 -80℃,持续时间 4min。成功阻断His束并置入永久起搏器。例 2男性, 65岁,因反复发作典型房扑并房颤入院。术前核磁共振显示左肺静脉严重狭窄,术中先用 8mm冷冻导管消融右房峡部,共消融 5个点后达峡部双向阻滞。再用一种可自动扩张的环形冷冻导管成功隔离右肺静脉。术中患者无疼痛,术后造影无肺静脉狭窄发生。结论:通过冷冻消融的初步临床应用,证明它是一种安全有效的治疗快速心律失常手段。

Primary Clinical Application of Catheter-Based Cryoablation in Patients With Atrial Flutter and Fibrillation

This paper reports the results of cryothermic ablation of paroxymal atrial flutter (AFL)with concomitant atrial fibrillation(AF).Case 1,a 79-year old male,experienced recurrent palpitation and syncope.Electrocardiogram showed paroxymal AF with rapid ventricular response of 190-220 bpm,which was refractory to antiarrythmic agents.We decided to use crocatheter to ablate the His bundle.Prior to cryoablation ,cryomapping performed,which consisted of cooling the tissue to a temperature of-30℃ for maximum time of 80 seconds was performed,when the target point was confirmed,cryoablation was performed by cooling the tissue to a temperature of -80℃ for 4 minutes.The patient's His bundle was successfully ablated and permanent pacemaker was implanted.Case 2 ,a 65-year-old male,presented recurrent typical AFL and paroxymal AF.MRI revealed serious stenosis of left pulmonary vein. First a 8-mm-tip cryocatheter was used to create the ablation line along the cavotricuspid isthmus,5 applications of cryoablation rendered the bi-directional conduction block of isthmus,then an expandable circular cryoablation catheter was used and right pulmonary vein isolation was successfully performed .The patients had no pain perception during the procedure.Post-ablation angiography revealed no stenosis of right pulmonary vein.Conclusion:The primary experience of clinical application shows cryoablation is a safe and effective method for the treatment of tachyarrythmias.