不同消融策略治疗阵发性心房颤动的临床研究

目的 研究不同射频导管消融（RFCA）策略治疗阵发性心房颤动（PAF）的临床效果.方法 将44例PAF患者分成两组：①肺静脉电隔离组（PVI）21例,应用Ensite3000 Navx系统和Lasso电极指导下进行环肺静脉电隔离.终点消融为：若房颤发生,在消融过程中房颤终止,且肺静脉电位（PVP）消失,或房颤未终止,但PVP消失 若在窦律下消融,PVP消失.②PVI联合左房线性消融（PVI＋LALL）组23例,除完成PVI外,进行左心房顶部线和峡部线的消融并达到完全阻滞.结果 ①PVI组21例PAF患者均顺利完成手术,手术时间189～267 min,X线暴光时间24～51 min,17例患者术中出现房颤,其中9例在消融过程中房颤终止且达到肺静脉电隔离,另外8例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.随访期间发现3个月后有67%的患者房颤消失或明显减少.②PVI＋LALL组23例PAF患者均顺利完成手术,手术时间234～297 min,X线暴光时间29～55 min,19例患者术中出现房颤,其中14例在消融过程中房颤终止且达到肺静脉电隔离,另外5例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.左心房顶部线全部达到完全阻滞,峡部线有5例未能达到完全阻滞.随访期间发现3个月后有86.9%的患者房颤消失或明显减少.与PVI组比较,PVI＋LALL组手术时间明显延长,房颤消融后的随访成功率明显增加（P＞0.05）.结论 环肺静脉电学隔离联合左心房线性消融可以明显提高房颤RFCA后的随访成功率.

Clinical study of different radiofrequency cathter ablation method for paroxymal atrial fibrillation

Objective To study the clinical effect of different radiofrequency catheter ablation （RFCA） method for paroxysmal atrial fibrillation （PAF）. Methods Forty-four cases were divided into pulmonary vein isolation group（ PVI group,21 cases） and pulmonary vein isolation combined with left atrium linear lesion group（ PVI ＋ LALL group, 23cases）. PVI group guided by EnSite NavX mapping system, and circle mapping catheter （Lasso）. The end point of ablation was pulmonary vein potential disappear. PVI ＋ LALL group were ablated the roofine and the mitral annulas isthmus achieved complete tion completely. The mean procedure time and fluoroscopy time were （227 ± 37） minutes 17 cases occured AF in operation, 9 cases of AF stopped and pulmonary vein were isolated in operation, the other 8cases achieved pulmonary vein isolation although AF didnt stop. 4 cases achieved complete PVI in sinus LALL group all reached the endpoint of ablation completely. The mean procedure time and fluoroscopy time were （277±41） minutes. Nineteen cases occured AF in operation, 14 cases of AF stopped and pulmonary veins were isolated in operation, the other 5 cases achieved PVI although AF didn＇t stop.Four cases achieved complete PVI in sinus rhythm. The rooflines were completed block. The mitral annulus isthmus were not completed block in 5 cases. During 3 months of follow-up, 86.9% patients were free or obviously decrease of AF. Compared with PVI group, PVI ＋ LALL group procedure time and follow up achievement ratio were obviously increased. Conclusions Circumferential PVI combined with LALL can obviously increase the catheter ablation follow up achievement ratio in PAF patients.