Lasso环状标测电极导管指导心房颤动持续过程中心脏大静脉电隔离

目的:报道2例心房颤动(房颤)持续过程中Lasso环状标测电极导管(Lasso电极)指导心脏大静脉 (大静脉)电隔离治疗。方法:2例患者临床症状和心电图记录提示分别为阵发性房颤(PAF)和持续性房颤。经股静脉和颈内静脉穿刺置入右心室和冠状静脉窦电极导管,并行房间隔穿刺和选择性大静脉造影。置入10极 Lasso电极进行大静脉标测。应用普通温控消融导管以局部异常电活动相对最早或频率最快、最紊乱处开始消融,在房颤持续过程中电隔离大静脉至左房连接处,以房颤终止和异常电活动消失或后者与心房电活动无关为消融终点。结果:2例患者共消融7条大静脉。1例PAF患者完成上腔静脉(SVC)和右上肺静脉(RSPV)电隔离后,消融左上肺静脉(LSPV)过程中房颤终止。另1例持续性房颤患者完成SVC、RSFV、LSPV及右下肺静脉电隔离,加做左房峡部、三尖瓣-下腔静脉峡部线性消融后,同步电复律使房颤转为窦性心律。随访1年,无房颤复发和相关并发症。结论:Lasso电极指导下应用普通温控消融导管可于心房颤动持续过程中电隔离大静脉而治疗房颤。

Electro-isolating cardiac venacava during atrial fibrillation guided by Lasso ring-designed electrode catheter

Objective:To report cardiac venacava electro-isolated during atrial fibrillation of two patients guided by Lasso ring-designed electrode catheter. Method:Two patients were suffered from paroxysmal and sustained atrial fibrillation respectively according to the clinical symptoms and ECG recording. Two multiple eletrode catheters were placed in the right ventricle and coronary sinus for mapping and stimulation. Two decapolar Lasso ring-designed electrode catheter were positioned into the venacava for mapping after atrial transseptal puncture and angi-ography of venacava were performed. The target venacava was that where the earliest activity was appeared at the onset of atrial fibrillation or the most irregular activity was recorded during atrial fibrillation. Radiofrequency energy was delivered at the junctions of the target venacava and left atrium during atrial fibrillation. The end point of procedure was the termination of atrial fibrillation and disappearance of focal activity from venacava. Results: There were seven venacavas ablated in two patients. The atrial fibrillation of one patient was ended by ablating left superior pulmonary vein (LSPV) .superior vena cava (SVC) and right superior pulmonary vein (RSPV). Another was ended by synchronous cardioversion after ablating left atrium isthmus, tricuspid valve, inferior vena cava isthmus, SVC, RSPV, LSPV and R1PV. The results during follow-up of one year were no recurrence of atrial fibrillation and no complications according to the atrial fibrillation. Conclusion: It's feasible for using lasso catheter to successfully treat atrial fibrillation by electro-isolating cardiac venacava.