递进式消融法治疗持续性心房颤动的初步体会

目的评价一种递进式消融法治疗持续性心房颤动（房颤）的疗效。方法34例持续性房颤患者，年龄（54．8±11．4）岁，病程（36．5±9．8）个月。按以下顺序进行递进式消融：环肺静脉前庭消融达肺静脉电学隔离，左心房顶部和二尖瓣环峡部线性消融，心房碎裂电位消融，针对房颤转变的心房扑动（房扑）／房性心动过速（房速）行Carto激动标测结合拖带技术以明确其机制，并力求通过消融终止。结果递进式消融法使88．2％患者房颤节律发生变化（直接终止或转变为房扑／房速），61．8％直接通过消融恢复窦性心律。随访（12．6±6．2）个月，82．4％患者维持窦性心律（其中42．9％服用胺碘酮）。结论递进式消融是治疗持续性房颤的一种有效方案。

Catheter ablation of persistent atrial fibrillation using a step-wise approach

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients mean age (54.8 ± 11.4) years] with persistent AF mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.