心房颤动上腔静脉节段性电隔离方法及安全性评估

目的:分析心房颤动(房颤)上腔静脉节段性电隔离的具体手术方法,并评估其安全性.方法:入选2017年11月至2018年9月期间我院阵发性房颤患者50例,患者常规进行肺静脉隔离后,继续行上腔静脉隔离.消融前进行上腔静脉造影,显示上腔静脉与右心房解剖关系,并在CARTO系统运用PentaRay电极导管进行上腔静脉及右心房三维...

Safety and Efficacy of Segmental Isolation of Superior Vena Cava During Atrial Fibrillation Ablation

Objectives:To report the safety and efficacy of segmental isolation of superior vena cava(SVC)during atrial fibrillation(AF)ablation.Methods:50 consecutive patients with paroxysmal AF,who underwent AF ablation from November 2017 to September 2018,were enrolled.After routine pulmonary vein isolation(PVI),segmental superior vena cava isolation was performed.Before ablation,superior vena cava angiography was performed to show the anatomical relationship between superior vena cava and right atrium,and three-dimensional anatomical reconstruction of superior vena cava(SVC)and right atrium(RA)was performed using PentaRay electrode catheter of the CARTO system.The ablation catheter was advanced to 1-2 cm above the junction between SVC and RA.Then,pacing ablation was performed along the wall of the SVC and the site of phrenic nerve reaction was determined and marked.The segmental linear ablation of the SVC could then be performed safely without injuring the phrenic nerves.Results:All patients received pulmonary vein isolation as well as SVC isolation.The superior vena cava potential isolation was achieved in 49 patients in the absence of diaphragmatic paralysis or sinoatrial node dysfunction.Complete SVC isolation was not achieved in one patient due to phrenic stimulation.No phrenic nerve injury and sinoatrial node injury related symptoms were noticed during the one-year follow-up.Conclusions:According to our experience,segmental superior vena cava isolation during atrial fibrillation ablation can be achieved safely with high success rate.