持续性心房颤动导管消融术强化间隔消融与术后左心耳激动延迟的关系

  目的  探讨持续性心房颤动(简称房颤)导管消融术后左心耳激动显著延迟与术中强化间隔消融的关系。  方法  对2007年6月至2009年2月在本科接受导管消融术的201例持续性房颤患者行步进式导管消融, 术后行左房激动标测并记录左心耳电活动, 术后1月行经胸心脏超声评估左房功能。  结果  术后23例出现左心耳激动显著延迟, 其中14例为初次消融病例, 9例接受了间隔线消融(OR 15.2, 95%CI 4.6~50.8, P < 0.001);另9例为第2次消融(包括2例左房隔离)病例, 9例患者也于初次消融中行广泛间隔复杂碎裂电位消融(P=0.002)。激动标测提示21例患者中18例(85.7%)左房最早激动部位转向冠状窦。术后1个月二尖瓣前向血流A峰为(18.2±17.0)cm/s, 与术前为窦性心律者比较显著下降, (20.2±19.1)cm/s vs.(58.2±17.9)cm/s(P=0.037)。随访(10.6±6.2)个月, 14例患者维持窦性心律。  结论  持续性房颤导管消融术行间隔线或广泛间隔复杂碎裂电位消融可导致左心耳激动显著延迟, 可能影响左房功能, 持续性房颤患者采用此术式应该慎重。

Relationship between Aggressive Septal Ablation and Significant Left Atrial Appendage Activation Delay following Catheter Ablation of Persistent Atrial Fibrillation

Objective To elucidate the significant left atrial appendage activation following ablation of persistent atrial fibrillation,and explore its relationship with aggressive septal ablation. Methods A total of 201 patients with persistent atrial fibrillation underwent catheter ablation from June 2007 to February 2009. Action mapping of left atrium was performed and the local potential of left atrial appendage was recorded at the end of the procedure. Transthroacic ultrasound was performed one month later to eva...