房颤患者环肺静脉电隔离术后快速性房性心律失常的再消融治疗效果分析

目的:观察心房颤动患者环肺静脉电隔离术(CPVI)后快速性房性心律失常(ATa)的再消融治疗效果,并探讨其可能的发生机制。方法:64例阵发性房颤患者在初次行CPVI后(3.7±2.4)个月再次行电解剖标测系统指导下ATa标测和消融。结果:共标测到78种ATa,其中48种(61.5%)为局灶性机制,30种(38.5%)折返机制。在折返机制中,12例为普通房扑,18例为左房内折返,其折返环与二尖瓣峡部、左房前壁及原环肺静脉消融线上的传导间隙有关。2例患者因ATa不稳定而无法标测。64例患者中,56例(87.5%)消融即刻成功,8例需要电复律成窦性心律。术后随访13~21个月,平均(16.5±2.9)个月,60例(93.8%)患者不再发生ATa。结论:CPVI术后ATa的机制可为折返性和局灶性,可通过CARTO系统激动顺序标测成功消融治疗。     

最大P波宽度及P波离散度对阵发性房颤环肺静脉隔离术后复发的预测作用

目的探讨最大P波宽度(Pmax)及P波离散度(Pd)对阵发性心房颤动(房颤)环肺静脉隔离术后复发的预测作用(circumferential pulmonary vein ablation,CPVA)。方法 69名因阵发性房颤接受环肺静脉隔离术的患者,在术前和术后窦性心律时分别测定记录Pmax和Pd,并对患者进行随访,了解其复发情况。结果随访8～36个月,共有16名患者房颤复发,复发组和无复发组在年龄、性别、病程、基础疾病、左房内径(LA)、左室舒张末期内径(LVed)、射血分数(EF)上差异均无统计学意义;两组术前及术后Pmanx、Pd差异均无统计学意义,但术前和术后Pmax及Pd在复发组均有高于无复发组的趋势。复发组术后Pmax小于术前(P<0.05),而无复发组术后Pmax、Pd及复发组Pd均有小于术前的趋势。结论 Pmax及Pd对预测阵发性房颤消融术后复发的作用尚不能确定,但左房内消融可能影响了折返激动的形成。仍需大规模临床试验进一步评价体表心电图对预测房颤消融术后复发的价值,从而筛选复发高风险患者,予以干预措施,减少CPVA术后房颤复发。     

Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation

Background  The effects of anxiety and depression on the recurrence of persistent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA) are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown.

Methods  One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA (CPVA group) and 103 treated with anti-arrhythmics drugs (medicine group), were enrolled. The Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS) were assessed before and 12 months after treatment in all patients.

Results  The scores of SAS (40.33±7.90 vs. 49.76±9.52, P <0.01) and SDS (42.33±8.73 vs. 48.17±8.77, P <0.01) decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group (17 patients), the scores of SAS and SDS were significantly lower in the non-recurrent group (26 patients) at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA.

Conclusions  Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF. 

     

Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping

Catheter ablation for the treatment of atrial fibrillation （AF） has been a focal target ofelectrophysiological study in recent years. Up to date, circumferential pulmonary vein ablation （CPVA） guided by three-dimensional （3-D） electreanatomic mapping （Carto, USA） has been one of the most favourable procedures for the treatment of AF. However, it is still difficult to acquire the detailed information on number, location, and branching pattern of all pulmonary veins （PVs） when the 3-D electroanatomic mapping system is used alone.     

Recurrent atrial tachycardia and atrial fribrillation after circumferential pulmonary vein ablation: What's the difference?

Background Recurrent atrial tachyarrhythmia (ATa) after circumferential pulmonary vein ablation (CPVA) includes atrial tachycardia (AT) and atrial fribrillation (AF). However, whether there are some differences in clinical course and mechanisms between the recurrent AT and the recurrent AF remained unclear. This study was conducted to investigate the incidence, mechanism, clinical course of the recurrent AT and AF in patients under CPVA.Methods One hundred and thirty consecutive patients (M/F=95/35) with highly symptomatic and multiple antiarrhythmic drugs (AADs) refractory paroxysmal (n=91) or persistent (n=39) AF were included. The ablation protocol consisted solely of two continuous circular lesions around the ipsilateral pulmonary veins (PV) guided by CARTO system. The endpoint of CPVA is PV isolation. For patients with recurrent ATa within 2 months after the initial procedure, cardioversion with direct current was attempted if the ATa lasted for more than 24 hours. A repeat ablation procedure was performed only for patients with AADs refractory recurrent ATa and at least followed up for 2 months after the initial procedure.Results Within 2 months after the initial procedure, 52 patients (40.0%) had experienced episodes of symptomatic recurrent ATa. Among them, 23 patients (44.2%) with recurred AT alone (AT group), 14 patients (26.9%) with recurred AF alone (AF group), and 15 patients (28.8%) with recurred AT and AF (AT plus AF group). The delayed cure rate (65.2%) in AT group was significant higher than that in AF group (21.4%, P<0.05) and AF plus AT group (26.7%, P<0.05). A repeat ablation was performed in 21 patients, including 6 patients with recurrent AT alone, 8 patients with recurrent AF alone, and 7 patients with recurrent AF plus AT. The mean number of PV gaps was 1.2±0.4 in AT group, which was significantly lower than that in AF group (2.6±0.7, P<0.05) and AF plus AT group (2.0±0.6, P<0.05). Delayed cure rate and number of PV gaps between AF group and AF plus AT group were comparable (P>0.05).Conclusions Present study indicates that recurrent AT and AF after CPVA have the different clinical course and different electrophysiological findings during repeat procedure as follows: ⑴After CPVA, spontaneous resolution of recurrent ATa was mainly found in patients with recurrent AT alone (about two thirds patients). ⑵The type of recurrent ATa after CPVA is associated with the number of PV gaps.     

不同射频消融方法治疗阵发性房颤的有效性与安全性的系统评价

目的:分析节段性肺静脉消融与环状肺静脉消融治疗阵发性房颤的有效性与安全性.方法:检索MEDLINE 、EBM等数据库,检索国内外已发表的相关文章.由2位评价者按上述检索策收集资料、按选择标准入选,对节段性肺静脉消融与环形肺静脉消融治疗阵发性房颤的方法的有效性、安全性进行描述性系统评价.结果:检索到2篇随机化临床对照试验文献,研究对象存在异质性,有效性研究终点不一致,Oral等的试验肺静脉环形消融有效率达到89%,而Martin等的试验环形消融有效率为54%,其中安全终点无差异.结论:从系统评价分析,尚不能得出环形肺静脉消融治疗阵发性房颤的有效性与安全性优于节段性肺静脉消融的结论,射频消融治疗房颤疗效的研究终点有待于进一步规范.     

阵发性心房颤动消融终点时诱发试验不同阴性结果预后差异

目的:探讨阵发性房颤患者环肺静脉电隔离术消融终点时诱发试验不同阴性结果预后差异?方法:回顾性选取133例因阵发性房颤接受消融且以诱发试验阴性(不能诱发或可诱发持续不超过3 min短阵房性心律失常)为消融终点?并成功达到终点的患者?所有患者均在环肺静脉电隔离后(定义为完成预设消融径线并达到肺静脉-左房双向电传导阻滞)行诱发试验,分别于冠状窦口及远端行猝发刺激(10 mA,脉宽2 ms),从300 ms递减直至心房失去1∶1夺获,如诱发持续>3 min短阵房性心律失常则进一步标测并进行局灶或折返环峡部消融?按照消融终点时诱发试验不同阴性结果分为不能诱发组(A组)和可诱发短阵(持续不超过3 min)房性心律失常组(B组)?空白期为3个月?患者术后定期随访心电图及Holter?结果:诱发终点情况:A组74例(55.6%),B组59例(44.4%)?术后平均随访(21.3 ± 10.9)个月,首次消融术后复发45例(A组25例,B组20例)?Kaplan-Meier生存分析显示两组复发时间无显著差异(P = 0.74)?结论:对于采用环肺静脉电隔离术,以诱发试验阴性为消融终点的阵发性房颤患者,消融终点时不可诱发房性心律失常预后并不优于终点时可诱发短阵(<3 min)房性心律失常者?     

Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system

Background The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.Methods Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group Ⅰ, n=40) and by the CARTO system (group Ⅱ, n=35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins’ (PVs’) ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium （LA）. The endpoint of the procedure was complete PVs isolation. Results Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group Ⅱ were significantly shorter than in group Ⅰ ［(150±23) min and (18±17) min versus (170±34) min and (25±16) min, P=0.03 and 0.04, respectively］. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group Ⅰ and group Ⅱ ［(8±4) min and (16±11) min versus (5±4) min and (14±8) min, respectively］. The fluoroscopic durations for CPVA were (15±5) min in group Ⅰ versus (10±6) min in group Ⅱ (P=0.05), and the CPVA procedural durations were significantly shorter in group Ⅱ than in group Ⅰ ［(18±11) min versus (25±10) min, P=0.04］. AF was terminated by radio frequency delivery in 14 cases (35%) in group Ⅰ versus 5 cases (14%) in group Ⅱ (P=0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group Ⅰ versus 11 cases (31%) in group Ⅱ (P=0.004). During a mean follow-up of 7 months, 32 (80%) cases in group Ⅰ and 24 (69%) cases in group Ⅱ were arrhythmia-free (P=0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group Ⅱ. One case had moderate hemothorax in group Ⅰ. All the complications were cured by proper treatment. No PV stenosis was observed. Conclusions The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.     

环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动的临床研究

目的 探讨环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动(PAF,简称房颤)的临床效果与安全性.方法 选择23例PAF患者,应用Ensite3000 Navx系统和Lasso电极指导下行环肺静脉电隔离及左房顶部线、峡部线消融.消融终点为:在消融过程中房颤终止,且肺静脉电位消失,或房颤不终止,但肺静脉电位消失;若在窦律下消融,肺静脉电位消失;左心房顶部及峡部线达到完全阻滞.结果 23例PAF患者均顺利完成手术,手术时间234～297 min,平均(277±41)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2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.结论 环肺静脉电隔离联合左心房线性消融治疗PAF 安全、可靠. Abstract： Objective To study the clinical efficacy and safety of circumferential pulmonary vein isolation of paroxysmal atrial fibrillation(PAF) combined with left atrial linear lesion. Methods Twenty-three PAF patients were performed circumferential pulmonary vein isolation combined linear lesion of left atrial isthmus and loof with Ensite 3000 Navx and Lasso electrodes guiding. Radiofrequency end point, atrial fibrillation stopped and pulmonary vein potentials(PVPs) disappeared, or atrial fibrillation did not stop, but PVPs disappeared. PVPs disappeared if atrial fibrillation was ablated during sinus rhythm. Left atrium loof and isthmus line were complete block.Results Twenty-three PAF patients were performed ablation, operation times were from 234 to 297 minutes, X ray time was from 29 to 55 minutes, 19 atrial fibrillations occurred during operation, of which 14 atrial fibrillations stopped with pulmonary vein isolation and linear lesion, the other 5 atrial fibrillations didn't stop, but which pulmonary veins were isolated. Tour patients were performed pulmonary vein isolation during sinus rhythm. All roof lines were completely block, and 2 left atrial isthmus lines were not completely block. 86.9% patients' atrial fibrillation disappeared or decreased significantly.Conclusions It is safe and efficient to treat PAF with circumferential pulmonary vein isolation combined with left atrial linear lesion.     

Myocardial injury resulting from radiofrequency catheter ablation: comparison of circumferential pulmonary vein isolation and complex fractionated atrial electrograms ablation

Background  Radiofrequency catheter ablation (RFCA) necessarily produces an area of myocardial necrosis. However, the difference of the extent of myocardial injury between circumferential pulmonary vein isolation (CPVI) and complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) has not been investigated before.

Methods  Twenty-nine consecutive male patients (n=29) with either paroxysmal or persistent AF were selected for CPVI or CFAE ablation. The CPVI or CFAE ablation was performed with a three-dimensional electroanatomical mapping system (CARTO). Serum cardiac biomarkers, for example, cardiac troponin T (cTnT), aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase myocardial bound (CKMB) were determined by the Elecsys STATE immunoassay. Cardiac structure and function were measured with echocardiography.

Results  Echocardiography showed that there was no significant difference of atrioventricular structure or function parameters between the CPVI group and the CFAE ablation group. Serum cTnT showed a significant increase in the CFAE ablation group over the CPVI group at 12 and 24 hours after the procedure (P <0.05, respectively), and then it was reduced to a normal level after 48 hours. Serum AST showed a significant increase in the CFAE ablation group over the CPVI group at post-procedure, 4 and 12 hours after the procedure (P <0.05, respectively), and then it reached to a normal level after 24 hours. There was no significant difference in LDH, CK, or CKMB levels between the CFAE ablation group and the CPVI group at any time point (P >0.05).

Conclusions  cTnT and AST other than LDH, total CK or CKMB activity significantly increased more in the CFAE ablation group than the CPVI group. However, the difference of the serum levels of cTnT, AST between two groups was temporary.

     

Recurrent atrial tachycardia and atrial fribrillation after circumferential pulmonary vein ablation: What’s the difference?

Background Recurrent atrial tachyarrhythmia (ATa) after circumferential pulmonary vein ablation (CPVA) includes atrial tachycardia (AT) and atrial fribrillation (AF). However, whether there are some differences in clinical course and mechanisms between the recurrent AT and the recurrent AF remained unclear. This study was conducted to investigate the incidence, mechanism, clinical course of the recurrent AT and AF in patients under CPVA.Methods One hundred and thirty consecutive patients (M/F=95/35) with highly symptomatic and multiple antiarrhythmic drugs (AADs) refractory paroxysmal (n=91) or persistent (n=39) AF were included. The ablation protocol consisted solely of two continuous circular lesions around the ipsilateral pulmonary veins (PV) guided by CARTO system. The endpoint of CPVA is PV isolation. For patients with recurrent ATa within 2 months after the initial procedure, cardioversion with direct current was attempted if the ATa lasted for more than 24 hours. A repeat ablation procedure was performed only for patients with AADs refractory recurrent ATa and at least followed up for 2 months after the initial procedure.Results Within 2 months after the initial procedure, 52 patients (40.0%) had experienced episodes of symptomatic recurrent ATa. Among them, 23 patients (44.2%) with recurred AT alone (AT group), 14 patients (26.9%) with recurred AF alone (AF group), and 15 patients (28.8%) with recurred AT and AF (AT plus AF group). The delayed cure rate (65.2％) in AT group was significant higher than that in AF group (21.4％, P&lt;0.05) and AF plus AT group (26.7%, P&lt;0.05). A repeat ablation was performed in 21 patients, including 6 patients with recurrent AT alone, 8 patients with recurrent AF alone, and 7 patients with recurrent AF plus AT. The mean number of PV gaps was 1.2±0.4 in AT group, which was significantly lower than that in AF group (2.6±0.7, P&lt;0.05) and AF plus AT group (2.0±0.6, P&lt;0.05). Delayed cure rate and number of PV gaps between AF group and AF plus AT group were comparable (P&gt;0.05).Conclusions Present study indicates that recurrent AT and AF after CPVA have the different clinical course and different electrophysiological findings during repeat procedure as follows: ⑴After CPVA, spontaneous resolution of recurrent ATa was mainly found in patients with recurrent AT alone (about two thirds patients). ⑵The type of recurrent ATa after CPVA is associated with the number of PV gaps. Chin Med J 2005; 118(21):1773-1778     

肥胖患者阵发性心房颤动环肺静脉电隔离术后的预后研究

目的评价肥胖患者阵发性心房颤动(房颤)环肺静脉电隔离术后的疗效及预后。方法入选2012年1月~2014年12月在我院首次行导管消融治疗的肥胖阵发性房颤患者70例(体重指数BMI≥28 kg/m2,肥胖组),同期选择按性别、年龄、房颤病程、基础疾病、CHA2DS2-VASc评分、左心房内径、左心室射血分数匹配的70例正常BMI的阵发性房颤患者(18.5≤BMI24 kg/m~2,正常组)。两组均采用环肺静脉电隔离术式治疗。术后随访12个月,比较肥胖组与正常组的复发率,并探讨肥胖对术后复发的影响。结果术后随访12个月,肥胖组的复发率高于正常组(27.1%vs 12.9%,P0.05)。单因素和多因素分析均显示高BMI、扩大的左心房内径是阵发性房颤导管消融术后复发的独立危险因子(P均0.05)。结论肥胖患者阵发性房颤导管消融治疗是有效的。肥胖、左心房扩大是术后复发的独立危险因素。     

EnSite NavX三维电生理系统指导下环肺静脉前庭隔离导管消融治疗心房颤动

目的 探讨EnSire NavX三维电生理系统指导环肺静脉前庭隔离导管消融治疗心房颤动(房颤)的有效性和安全性.方法 在EnSite NavX三维电生理系统指导下对38例药物治疗无效的阵发性或持续性房颤患者行环肺静脉导管消融,随访观察其疗效和安全性.结果 38例患者都达到消融终点,双侧肺静脉均完全隔离.手术操作时间(233.8±31.7)min,X线曝光时间(32.5±4.7)min,左房建模时间(27.5±7.5)min.术后随访(9±3)月,单次消融的成功率为89.5%,出现并发症7.9%.结论 EnSite NavX三维电生理系统指导下环肺静脉前庭隔离导管捎融治疗房颤是一种较为有效且安全的方法.     

三维标测系统指导下肺静脉隔离及左房线性消融治疗心房颤动

目的在三维标测系统(CARTO)指导下进行肺静脉隔离治疗心房颤动(房颤)。方法选2例阵发房颤病人,在CARTO系统指导下建立左房及肺静脉三维电解剖图像,并环肺静脉口周围消融,实现肺静脉与左房电隔离。结果随访3个月,房颤无复发,无血栓及肺静脉狭窄等并发症发生。结论三维标测系统指导下肺静脉隔离治疗房颤安全有效。     

Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

Background Delayed cure had been observed in recurrent cases after index ablation of atrial fibrillation (AF), however, its mechanism and incidence have not been elucidated in detail. This study aims to investigate the impact of different ablation strategies on the incidence of delayed cure and its possible mechanisms after trans-catheter ablation of AF. Methods One hundred and fifty-one consecutive cases with highly symptomatic, drug refractory AF were included in this study ［M/F=109/42, mean age （56.0±11.2） (18-79) years］. Segmental pulmonary vein ablation (SPVA) was performed in 83 patients with the guidance of circular mapping catheter (SPVA Group), circumferential PV linear ablation (CPVA) was carried out in the rest 68 cases under the guidance of 3 dimensional mapping system in conjunction with circular mapping catheter (CPVA Group). Delayed cure was defined as that early recurrence of atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter) after ablation procedure was no longer observed during subsequent follow-up, and stable sinus rhythm was maintained ≥2 months. Results Early recurrence of atrial tachyarrhythmias was detected in 41 cases from SPVA group and 23 cases from CPVA group, and delayed cure occurred in 21.9% (9/41) of the cases from SPVA group and 47.8% (11/23) of the cases from CPVA group, more delayed cure in later group was observed (P&lt;0.05). Meanwhile, patients in SPVA group took a longer time to achieve a delayed cure ［(27.0±18.0) days vs （14.0±8.1） days, P&lt;0.05］, and presented more recurrent episodes ［(3.50±1.08) times a week vs （2.42±1.11） times a week, P&lt;0.05］. However, recurrent episodes after index ablation were markedly decreased in cases with delayed cure from both groups (P&lt;0.05). Conclusions Despite of an early recurrence of atrial tachyarrhythimas after index ablation of AF, delayed cure occurs in a significant number of patients undergoing either SPVA or CPVA. However, different ablation strategies place different impact on the delayed cure, more delayed cure is obtained with CPVA approach, and the delayed cure occurs earlier with this approach; the average recurrent episodes before delayed cure are also less frequently detected in CPVA group compared with those in SPVA group.     

Initial experience with circumferential pulmonary vein isolation guided by Overlay Ref and CartoMerge in the treatment of paroxysmal atrial fibrillation

Background CartoMerge has been widely used in guiding circumferential pulmonary vein isolation （CPVI） for the treatment of paroxysmal atrial fibrillation （PAF）. However, the procedure of landmarks selection varies among operators according to their experience. Techniques have to be established to standardize this procedure. We propose that Overlay Ref could facilitate this procedure. This paper aimed to report our initial experience with CPVI guided by Overlay Ref and CartoMerge for the treatment of PAF. Methods Fifty-nine patients with PAF were enrolled in this study. Using Overlay Ref technique, a reference image （inverted） was faded into the live fluoroscopic image. Landmarks of CartoMerge were selected from anatomic points of the top of superior pulmonary veins （PVs） and the bottom of inferior PVs guided by Overlay Ref image. Overlay Ref images were also used to guide the ablation procedure combining with CartoMerge. Results All patients were successfully mapped by CartoMerge guided by Overlay Ref. The distance between the mapping points and the CT surfaces was （1.42±0.67） mm for the patients as a whole. This led to a successful rate of 96% for isolation of pulmonary veins. Duration of ablation procedure was （92±17） minutes. And the total duration of procedure was （139±32） minutes. CartoMerge could also be performed just with 3 paries to 4 paries selected landmarks guided by Overlay Ref without a full anatomic model constructed by Carto. Then, the total duration of procedure could be shortened to （115±38） minutes. Conclusions Overlay Ref technique can facilitate the catheter ablation of PAF and can help to standardize the procedure of landmarks selection.     

Pulmonary vein occlusion and remodeling after electrical isolation treatment for atrial fibrillation: a case report

Pulmonary vein (PV) stenosis or occlusion is a recently described complication of radiofrequency ablation for atrial fibrillation (AF), though favorable results of PV ostial ablation have fueled great enthusiasm. The presenting symptoms include dyspnea, cough, hemoptysis, pleural infusion and pulmonary consolidation.     

非接触三维标测系统指导下环肺静脉电隔治疗心房颤动的临床评价

目的:探讨非接触三维标测系统指导下环肺静脉电融隔离治疗心房颤动(房颤)的可行性和临床疗效.方法:28例药物治疗无效或不能耐受的房颤患者.其中23例阵发性房颤、5例持续性房颤.采用非接触三维标测系统(Ensite navX)建立左心房、肺静脉的三维等时电势图和电解剖图,并在距离肺静脉口1～2 cm处行环肺静脉及其周围组织电隔离.消融终点包括:完成所有环肺静脉消融径线;全部肺静脉均达电隔离;阴性诱发结果.结果:28例患者均达到消融终点;手术的总操作时间和X线曝光时间分别为(161.3±23.2)min和(38.0±6.8)min;随访6～17月,20例(71%)无房颤发作;8例(29%)有房颤复发,其中2例因其发作次数及时间均较术前明显减少未再消融,予以可达龙治疗可控制(术前可达龙治疗无效),6例行第2次消融,术中均发现肺静脉电位有不同程度的恢复,第2次术后4例房颤无再发,2例仍有发作但未再消融,予以可达龙治疗可控制.术中及随访期间无任何操作相关并发症.结论:非接触三维标测系统指导下的环肺静电隔离是治疗房颤的有效而安全的方法.肺静脉既是房颤的诱发机制,亦有可能参与房颤的维持.     

阵发性心房颤动两种射频消融术式的随机对照研究

目的:比较优化导管射频消融术(optimized radiofrequency catheter ablation,ORFCA)和环肺静脉隔离术(circumferential pulmonary vein isolation,CPVI)治疗阵发性心房纤颤(atrial fibrillation,AF)的有效性、安全性。方法:2009年3月至2010年3月于郑州市第七人民医院心内科行射频消融术(radiofrequency cather ab-lation,RFCA)治疗的阵发性AF患者随机分为CPVI组(n=40)和ORFCA术(n=44)。两组采取不同的消融术式,观察患者的左心房直径、房颤持续时间、左心室功能,成功率、并发症发生情况、消融点数、手术时间、曝光时间等数据,并比较两组之间的差别。结果:通过对CPVI组和ORFCA组基本情况的比较我们发现两组的性别组成、年龄、发作病史、左心房直径、左心室功能、应用抗心律失常药物种类方面无差别。CPVI组在消融点数、手术时间、曝光时间、成功率上均小于ORFCA组,差异有统计学意义(P<0.05)。两组在并发症发生率上无差别。结论:ORFCA术具有和CPVI术相似的安全性,和相对较高的有效性。