心房颤动递进式线性消融后的左心房扑动

目的旨在探讨心房颤动（房颤）递进式线性消融术中出现的房性心律失常的电生理特点及消融的结果。方法对80例房颤消融中出现规律的房性心律失常进行非接触激动顺序标测,判断电生理机制并指导消融。结果共146阵心动过速,4阵为左心房房性心动过速（房速）,周长为（225±49）ms,其余142阵为左心房扑动,左心房激动时间占心动过速周长的100％,周长为（205±37）ms,均与房颤“7”字消融线上的缝隙有关。根据缝隙的位置将心房扑动的折返环分为3类：Ⅰ类（n=68）,缝隙位于左心耳-左上肺静脉间的嵴部,Ⅱ类（n=50）,缝隙位于左心房顶部,Ⅲ类（n=24）,缝隙位于二尖瓣环峡部。其中130阵消融成功,其余16阵因消融反应欠佳后经药物或体外电转复为窦性心律。随访（16．2±6．7）个月,82．5％（66／80）的患者可维持窦性心律。结论房颤递进式线性消融术中出现的房性心律失常多为大折返机制,且与“7”字消融线上的缝隙有关,这些缝隙主要位于左心耳-左上肺静脉间的嵴部。非接触标测技术能快速准确地识别这些缝隙并指导消融。     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

应用盐水灌注消融导管进行肺静脉-心房电隔离治疗阵发性心房颤动

目的探讨应用盐水灌注消融导管对肺静脉-心房(PV-LA)电隔离治疗阵发性心房颤动(房颤)的效果.方法26例患者,男性22例,女性4例,年龄31～69(52±11)岁,均有阵发性房颤病史.患者分为2组,第1组15例应用普通4 mm电极温控导管消融,第2组11例应用盐水灌注导管消融.所有患者均在环状标测电极导管指导下行3根或4根肺静脉(PV)消融.结果第1组15例患者第1次消融了50根PV,即刻PV-LA电隔离成功率92%,手术时间平均3.5 h.其中在2例因房颤复发行第2次消融的患者中,第1次消融的7根PV中有6根(86%)恢复了与LA间的传导.第1组随访平均13个月,无房颤发作者8例(53%,含2例经再次消融患者),有效3例(20%).第2组11例患者第1次消融了44根PV,即刻PV-LA电隔离成功44根,成功率100%,11例手术时间平均2.8 h,1例应用盐水灌注消融导管消融时发生心脏压塞.第2组随访平均4个月,无房颤发作者7例(64%),有效2例(18%).结论应用盐水灌注消融导管进行PV-LA电隔离可能(1)缩短PV-LA电隔离所需的时间和提高成功率;(2)减少术后PV-LA电传导恢复的可能性,从而减少复发率;(3)初步结果表明应用盐水灌注消融导管较安全,但是否增加PV狭窄和心脏压塞等并发症尚需进一步的资料.     

阵发性心房颤动机制的心内非接触式标测初步研究

目的　阵发性心房颤动 (paroxysmalatrialfibrillation ,PAF)的发生和维持机制仍不甚明了 ,尤其缺少人类在体的心内标测证据。本组采用心内非接触式标测技术观察PAF的机制并指导消融。方法　 15例患者 (男性 13例 ,女性 2例 ) ,年龄 34～ 6 6平均 (5 2± 9)岁 ,左心房 (leftatrium ,LA)内径 2 2～4 0 (32 6± 6 2 )mm。均经房间隔穿刺在LA内对PAF进行非接触式标测 ,观察冲动的传导 ,并在其指导下对关键的传导通路进行线性消融以终止PAF。结果　 15例中有 7例自发和 8例诱发的PAF ,等电位标测显示PAF时LA内的冲动大致可归纳为以单个折返性波阵面为主 (Ⅰ型 )和有 2个子波 (Ⅱ型 )的两种类型。其冲动的传导表现出总体的随机性与局部或一定时间相对有序相交织存在的特点。PAF平均周长(16 1 3± 2 0 0 )ms ,其中Ⅰ型PAF为 (16 5 4± 2 0 7)ms,Ⅱ型为 (15 3 3± 17 2 )ms,差异有显著性 (P <0 0 5 )。无论是自发还是诱发 (经冠状静脉窦远端 35 0～ 6 0 0次 /minS1S1刺激 )的PAF ,左、右肺静脉 (pulmonaryvein ,PV)口周围 ,LA上部及后壁均是折返或子波的主要传导通路。 4例PAF在LA上部可见明显的狭窄传导区 ,此处放电 3～ 13次平均 (7 0± 4 5 )次 (5 5～ 6 0℃ ,30s)即可终止PAF ;另有 7例在分别对左、     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

经导管线性消融术对左心房功能影响的研究

目的评价左心房线性消融术对心房颤动（房颤）患者左心房功能的影响。方法选择30例Carto系统标测指导下行左心房线性消融术的阵发性房颤患者，应用超声心动图测定其消融术前1～3d、术后3个月静息时窦性心律下左心房容积指标、二尖瓣口A波速度峰值（VA）及左心房射血力，分析消融术前后左心房功能的变化。结果消融术后反应左心房辅泵功能的指标左心房射血力、VA、左心房主动排空容积、左心房主动排空分数、左心房总排空分数显著下降，反应左心房管道功能的左心房管道容积增加，反应左心房储存功能的指标左心房总排空容积、左心房最大容积无明显变化。结论Carto系统标测下左心房线性消融术后左心房辅泵功能下降，管道功能增强，而储存功能无显著改变。     

环状标测电极指导下射频消融治疗阵发性房颤的临床分析

目的探讨环状标测电极指导下射频消融治疗阵发性心房颤动的疗效。方法对23例阵发性房颤患者在环状电极指示下行经验性肺静脉和（或）上腔静脉电隔离。结果23例阵发性房颤患者中共隔离肺加上腔静脉87条，左上肺静脉22条，左下肺静脉18条，右上肺静脉22条，右下肺静脉12条，上腔静脉13条，平均每例3．78条。平均操作时间和X线透视时间分别为（148±34）min和（52±9）min。1例发生术中心包填塞，2例行2次手术。平均随访（3．8±1．6）个月，20例无房颤复发，2例有房早发作，成功22例。结论阵发性心房颤动采用环状标测电极指导下射频消融电隔离术对绝大多数患者是有效的，并能改善患者的心功能情况。     

经导管点状射频消融反复短阵"心房颤动"

目的　报道反复短阵快速房性心律失常的电生理特性、射频导管消融方法和结果。方法　对 32例自发的反复短阵快速房性心律失常患者进行射频导管消融。观察房性心律失常的心内激动顺序和周长。单极和双极标测快速房性心律失常的起源病灶 ,并进行消融。结果　 32例患者的快速房性心律失常的心电图表现酷似心房颤动。AA间期绝对不齐 16 0～ 4 5 0ms,平均 (2 87± 93)ms ,而心房激动顺序则绝对规整有序。局部点状消融成功治疗所有患者的房性心律失常。平均随访 (14± 8)个月 ,1例复发。结论　反复短阵快速房性心律失常是一种局灶性房性心动过速 ,而非心房颤动。点状消融可达到根治的目的。     

射频消融治疗局灶性心房颤动初步结果

目的　评价射频消融治疗由房性早搏 (房早 )诱发的局灶性心房颤动 (房颤 )的安全性和可靠性 ,并探讨有关射频消融治疗中一些方法学问题。　方法　 1例 44岁女性患者 ,阵发房颤 4年余 ,心电图证实房颤由房早诱发 ,药物治疗无效 ,行射频消融治疗。放置常规电生理检查导管和 Halo导管 ,穿刺房间隔 ,大头导管经房间隔在左房内肺静脉进行标测 ,在左上肺静脉内标测到诱发房颤的房早时最早心房激动 ,放电消融 3次 ,房早、房颤消失。结果　随访两周后有房早和短阵房颤发生 3次 ,术后两周至 6个月未服用药物 ,无房颤发生。结论　射频消融可能成为治疗局灶性房颤一种安全有效的方法。     

阵发性心房颤动的电生理机制及导管射频消融的初步研究

目的　探讨阵发性心房颤动 (房颤 )的电生理机制和右房峡部消融对房颤的影响。方法　1 995年 6月～ 1 999年 6月 ,1 5例药物治疗无效的阵发性房颤 ,男性 8例 ,女性 7例 ,年龄 (5 6± 9)岁 ,病程 (7± 4)年 ,消融前 3个月平均每月发作 6次至每日数十次不等 ,发作时均有明显症状 ;对照组 1 5例房室结折返性室上性心动过速 ,男性 5例 ,女性 1 0例 ,年龄 (5 7± 6 )岁。电生理检查及消融 ,房颤组和对照组均测量房室结正向和逆向传导文氏点 (Wenckebach point)。程序电刺激诱发房颤 ;在右房峡部线性消融。结果　房颤组房室结正、逆向文氏点分别为 (34 0± 38) m s和 (6 1 8± 75 ) ms,两者差异具有显著性 (P<0 .0 0 1 ) ;对照组正、逆向文氏点分别为 (34 5± 5 2 ) ms和 (338± 48) m s,两者之间差异无显著性 (P>0 .0 5 ) ;两组间正、逆向文氏点离散度差异 (正、逆向文氏点之差 )具有显著性 (P<0 .0 0 1 )。房颤组可用短阵快速刺激 (burst)诱发房颤 ,9例房颤由心房扑动 (房扑 )蜕变而成 ,7例消融后即刻成功 ,随防 3个月～4年 ,3例无房颤复发 ,1例随访时间最长达 3年 6个月 ;其余病例房颤发作频度较术前减少 70 %～95 %。结论　部分阵发性房颤患者在右房内与房扑一样存在大折返环 ,这些患者房颤由房扑蜕变而来     

经导管射频消融治疗肥厚性心肌病合并心房颤动的初步经验

目的报道经导管射频消融治疗肥厚性心肌病（HCM）伴心房颤动（房颤）,并对其可行性、安全性、有效性进行评价。方法回顾性分析2006年8月至2008年10月期间因HCM伴房颤且药物治疗效果较差至南京医科大学第一附属医院行经导管射频消融治疗的患者临床资料。患者均接受三维标测系统（Carto或EnSite—NavX）导航下环肺静脉消融术达到同侧肺静脉隔离,对持续性房颤再行左心房碎裂电位消融以及线性消融。消融术后3个月内继续服用抗心律失常药物,并于消融术后1、3、6个月行动态心电图检查,出现症状后立即行常规心电图,随访治疗效果。结果共11例HCM患者行射频消融术,年龄（52±17）岁,女性2例。其中6例为阵发性房颤,5例为持续性房颤。经导管射频消融后4周有1例因急性左心功能不良死亡,其余10例有4例复发,其中2例再次接受消融术。随访（14±10）个月,共有7例维持窦性心律,总成功率64％,未发生消融术相关的严重并发症。维持窦性心律者左心房内径及射血分数变化差异无统计学意义[（46±4）mmVS（46±4）mm,0．64±0．05VS0．66±0．04,P〉0．05],心功能改善（2．0±0．7VS1．2±0．4,P〈0．05,NYHA分级）。结论本文结果提示射频消融治疗HCM伴房颤安全且有效,术后维持窦性心律者心功能得到显著改善。     

超声技术评价不同的消融术式对阵发性心房颤动患者左心房功能的长期影舷

目的探讨不同的射频消融术式对阵发性心房颤动(PAf)患者左房功能的远期效应。方法PAf患者65例,接受节段性肺静脉隔离术(SPVI)27例和左房线性消融术(CPVA)38例,术后平均随访6~27(14.9±5.5)个月,应用超声心动图观察消融成功者手术前、后左房功能的变化,采用M型和二维超声测量左房内径,多普勒测量二尖瓣血流频谱,组织多普勒测量二尖瓣环舒张晚期运动速度(Va)。结果①SPVI组的27例患者中18例消融成功(66.7%),CPVA组的38例患者中28例消融成功(73.7%);②2组中消融成功者术前左房大小相似,术后长期维持窦性心律时左房内径减小(P<0.05);③消融成功者左房收缩功能好转,心房收缩期A波峰速度和积分都较术前升高(P<0.05),SPVI组的左房充盈分数比术前增加(P<0.05),CPVA组内左房射血力和左房充盈分数与术前比较差异无统计学意义;2组间比较血流频谱指标无差异,SPVI组Va高于CPVA组。结论射频消融术是治疗PAf的有效方法,长期随访显示消融成功者左房结构和收缩功能好转,但CPVA可能对左房局部收缩功能有影响。     

心内非接触式标测指导右心房峡部依赖型心房扑动的消融

目的 心内非接触式标测能提供高密度的心内膜等电位标测,可采用此技术指导对有大折返环路的右心房峡部依赖型心房扑动(atrial flutter, AFL)进行消融。方法 22例患者(男性21例,女性1例)平均年龄15～65(38.0±12.8)岁。全部患者均在术前记录到典型的峡部依赖型AFL心电图。其中6例有心脏外科手术史,1例有复杂先天性心脏病,2例伴有明显的心脏扩大,8例患者曾经导管消融失败或复发。全部患者均采用右心房内非接触式标测引导在三尖瓣环-下腔静脉口(TVA-IVC)之间进行线性消融并检验消融线的完整性。结果 22例患者中18例标测到自发的AFL,4例由心房刺激诱发。全部病例中20例为逆钟向型AFL,2例顺钟向型。心内非接触式标测在所有病例均观察到经过峡部的大折返环路且行进方向与体表心电图吻合。在峡部进行TVA-IVC线性消融后,分别在冠状静脉窦口和右心房下外侧起搏时以非接触式标测证实消融线的完整性,全部患者的消融均获得即时成功,且不再服用抗心律失常药物,平均随访3～36(21.1±9.1)个月,无AFL复发,2例心脏扩大者均基本恢复正常。结论 心内非接触式标测技术可以直观、准确地观察到心房扑动的折返环路且指导进行有效的线性消融。     

射频导管消融治疗青年人群心房颤动的临床分析

目的 对青年心房颤动（房颤）患者（≤45岁）接受三维标测系统指导下房颤射频导管消融治疗的临床疗效和安全性予以研究.方法 回顾分析兰州军区兰州总医院自2011年1月至2012年5月在EnSite 3000指导下接受房颤射频消融治疗的152例患者,按年龄分为青年房颤患者（≤45岁）和中老年房颤患者（＞45岁）,对比分析其在临床基线资料、消融术时间、X线曝光时间、住院天数、术后复发率、术后6个月服药率和并发症发生率等临床指标上的差异.结果 与中老年房颤患者（n=125）相比,青年房颤患者（n=27）多以阵发性房颤为主（P＜0.05）,且术前左心房内径较小（P＜0.01）,消融术时间明显缩短（P＜0.01）,术后住院天数减少（P＜0.01）,复发率和术后6个月服药率均明显减少（P＜0.05）.结论 青年房颤患者多以阵发性房颤为主且较少伴有高血压、糖尿病等疾病,接受房颤消融术后恢复较快且房颤复发率低.     

Visualization of catheter ablation for atrial fibrillation: Impact of devices and anatomy

Endocardial access to the left atrium is commonly achieved to treat patients with atrial fibrillation, using different device delivery systems for cardiac ablation. But the large variation in human anatomy presses the limits of existing medical devices. In this unique study, we directly visualized the device-tissue interface in fresh reanimated human hearts using Visible Heart^® methodologies. Our goal was to better understand any opportunities to improve therapeutic approaches. The visual images obtained in this study (also featured in this article) allow a more intimate grasp of the key steps required in various ablation procedures, as well as some limitations of current device designs. These images show the potential risks of conducting transseptal punctures and the difficulties of placing catheter tips in certain scenarios (e.g., when creating circumferential lesions); they also demonstrate potential problems that could occur while attempting to place catheter tips on such anatomies like the mitral isthmus. In our analysis of these images, we focus on where enhancements are needed to refine device functionality.