Impact of different termination modes on atrial fibrillation termination in catheter ablation of persistent atrial fibrillation

Background  The optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.

Methods  Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.

Results  During initial ablation, 33 patients (11.3%) were directly converted to SR, 166 patients (56.7%) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4%), and a total of 162 patients (55.3%) underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2% vs. 43.8%, P=0.328) and SR maintenance (67.2% vs. 59.8%, P=0.198) during the (23±7) months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups (72.5% vs. 70.4%, P=0.686). Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P <0.05). Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode: AF or AT (P <0.05).

Conclusions  Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.

     

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.     

Catheter ablation for atrial fibrillation after an unsuccessful surgical ablation and biological prosthetic mitral valve replacement: A pilot study

BackgroundPatients with mitral valve (MV) disease and atrial fibrillation (AF) undergo simultaneous prosthetic valve replacement and radiofrequency (RF) ablation procedure; however, this combinational procedure restores sinus rhythm (SR) in only 68–82% of the cases. In patients with ineffective surgical ablation, the use of a biological prosthetic valve might not only be a good choice to perform safe catheter ablation procedure in the left atrium (LA), but also provide a way to discontinue administration of oral anticoagulants. The objective of this study was to assess the efficacy of catheter ablation for AF after MV replacement with a biological prosthesis and an ineffective surgical ablation procedure.MethodsTen consecutive patients aged 48 ± 7 years were enrolled in this study. All patients had long-persistent AF associated with a rheumatic valve disease, which was treated by MV replacement with a biological prosthesis and a surgical RF ablation procedure. In the late postoperative period, all the patients had recurrent hemodynamically significant AF, which required repeated cardioversions. From 1 year to 3 years after the surgery, catheter ablation was performed, including reisolation of pulmonary veins (PVs) with the ablation of ganglionic plexi or linear lesions on the roof of the LA and mitral isthmus. The efficacy was assessed at 3 months, 6 months, and 12 months after the procedure.ResultsRestoration of SR during ablation was achieved in all of the cases. In 6–9 months, all the patients were free of arrhythmia. LA stunning manifested by the absence or decrease of the “A” wave in the transmitral flow and the retrograde wave in the PV flow was observed in nine patients with SR. In five of the patients, LA contractile function was restored in 1–6 months. Prosthetic valve dysfunction was not detected in any of the patients.ConclusionCatheter ablation is an effective method for AF treatment following an ineffective surgical RF ablation procedure and biological prosthetic MV replacement. The use of bioprosthetic MVs allows for performing safe catheter ablation without subsequent prosthetic dysfunction.     

导管射频消融术对房颤患者左心房结构的影响

目的评价导管射频消融术对心房颤动(AF,房颤)患者左心房结构的影响。方法 43例房颤患者接受治疗,其中阵发性房颤32例,持续性房颤11例。8例行肺静脉电隔离术,35例行Carto指导下环肺静脉前庭隔离术,消融终点均为双侧肺静脉完全电隔离。应用超声心动图测定其消融术前1~3 d和术后1、3个月静息时窦性心律下左心房内径,分析消融术前、后左心房结构的变化。结果 43例房颤患者均成功施行环肺静脉左房线性消融术,随访时间(6±2)月,最短3个月,最长14个月,治愈率93.02%。左房内径消融术后1个月较术前无明显改变[(35.74±5.77)mm vs(35.69±6.25)mm,P>0.05],随访3个月时左房内径较术前显著减小[(31.99±3.66)mm vs(35.69±6.25)mm,P<0.01]。结论房颤患者于术后3个月时左房结构可逆重构。     

Linear ablation of left atrium for the treatment of atrial fibrillation guided by double Lasso catheters and three dimensional electroanatomical mapping

Catheter ablation for the treatment of atrial fibrillation (AF) was a topic of electrophy-siological study in recent years.1-4 Linear ablation of left atrium (LA) guided by three dimensional (3-D) electroanatomical mapping (Carto) has been widely accepted by electrophysiologists since the clinical use of 3-D mapping systems in catheter ablation of AF. However, the previous procedures of CPVA were mainly via pure anatomical approaches.5-8 While recent studies showed that complete isolation…     

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     

以环肺静脉消融为基础分步消融治疗心房颤动

目的探讨在三维标测系统指导下，以环肺静脉消融为基础，分步消融治疗心房颤动（房颤）的可行性和有效性。方法对12例药物治疗无效的阵发性房颤（10例）和持续性房颤（2例）患者，以三步消融方法进行消融：环肺静脉前庭消融、节段性肺静脉消融和碎裂电位 (CFAEs) 消融。以每个阶段房颤不再被诱发作为消融终点,或完成三个阶段。结果消融结束时，10例阵发性房颤不再被诱发，其中第1阶段7例，第2阶段2例，第3阶段1例。2例持续性房颤在完成所有3个阶段后仍持续发作，最后经体外电转复。3例于术后2d内短暂复发，继续随访后未再房颤复发，1例房颤并典型心房扑动（房扑）患者术后复发房扑，无房颤复发。所有患者经(10±4)个月随访后，均无房颤复发，无左房房性心律失常出现。手术无并发症发生。手术中放电时间(38±11)min, X线透视时间(37±11)min，操作时间(3.0±0.5)h。结论 以房颤不再被诱发为手术终点、以环肺静脉消融为基础的分步消融治疗房颤策略是安全可行的。对于阵发性房颤采用环肺静脉消融术式即有良好效果，而对单纯环肺静脉消融不成功者结合节段性肺静脉消融及碎裂电位消融可进一步提高成功率。     

风湿性心脏病慢性心房颤动f波振幅的电生理研究

目的:对风湿性心脏病(风心病)慢性心房颤动(房颤)的房波电振幅特点进行研究,以探讨其在房颤产生和持续中的意义.方法:选择44例风心病慢性房颤患者在术前作16导左、右房同步心外膜标测图并进行分析,同时与10例室上速(对照组)心内电生理检查结果进行比较.结果:风心病慢性房颤患者A波,左房后壁中、下部f波振幅明显低于对照组A波,左房后壁上、中、下部位f波振幅明显低于右房(P＜0.05). 14例房颤电复律后心房各部位的A波幅明显大于术前f波振幅(P＜0.01),左心耳f波振幅显著大于左房后壁上、中、下部,左房后壁上部f波振幅显著大于左房后壁中部.风心病慢性房颤患者f波振幅与心房内径和容积无相关.结论: 左房后壁中、下部f波振幅最低,在左房心耳、左房上和左房中、下部之间存在明显电位差,提示左房中、下部是最易产生各向异性传导的部位,推测为AF起源,在明显电位差的部位易形成折返环.     

Changes of IK,ATP current density and allosteric modulation during chronic atrial fibrillation

Background Atrial fibrillation (AF) is the most common supraventricular arrhythmia in clinical practice. Chronic atrial fibrillation (CAF) is associated with ionic remodeling. However, little is known about the activity of ATP-sensitive potassium current (IK,ATP) during CAF. So we studied the changes of IK,ATP density and allosteric modulation of ATP-sensitivity by intracellular pH during CAF.Methods Myocardium samples were obtained from the right auricular appendage of patients with rheumatic heart disease complicated with valvular disease in sinus rhythm (SR) or CAF. There were 14 patients in SR group and 9 patients in CAF group. Single atrial cells were isolated using an enzyme dispersion technique. IK,ATP was recorded using the whole-cell and inside-out configuration of voltage-clamp techniques. In whole-cell model, myocytes of SR and CAF groups were perfused with simulated ischemic solution to elicit IK,ATP. In inside-out configuration, the internal patch membranes were exposed to different ATP concentrations in pH 7.4 and 6.8.Results Under simulated ischemia, IK,ATP current density of CAF group was significantly higher than in SR group ［(83.5±10.8) vs. (58.7±8.4) pA/pF, P&lt;0.01］. IK,ATP of the two groups showed ATP concentration-dependent inhibition. The ATP concentration for 50% current inhibition (IC50) for the SR group was significantly different in pH 7.4 and pH 6.8 (24 vs. 74 μmol/L, P&lt;0.01). The IC50 did not change significantly in CAF group when the pH decreased from 7.4 to 6.8.Conclusions During CAF, IK,ATP current density was increased and its allosteric modulation of ATP-sensitivity by intracellular pH was diminished.     

微纤维蛋白1在瓣膜性心房颤动患者心房组织中的表达及其与心房纤维化的关系

目的：观察微纤维蛋白1（FBN-1）在风湿性心脏瓣膜病并发心房颤动（AF）患者心房组织中的表达,探讨FBN-1与心房纤维化的关系。方法：选择因风湿性心脏瓣膜病住院并行瓣膜置换手术的患者84例,分为AF组39例和窦性心律（SR）组45例;收集整理患者的临床资料,并于手术中获取右心房组织（0.3~0.5 mm³）。Masson 染色观察2组患者右心房纤维化程度;Western blotting法测定各组患者心房组织中FBN-1蛋白的表达,相关分析探讨FBN-1与心房纤维化的关系。结果：2组患者在性别构成比、年龄、血压、血常规和生化指标等方面比较差异无统计学意义（P>0.05）。AF组患者左和右心房直径明显大于SR组（P<0.05）;Masson 染色,AF组患者心房组织存在明显纤维化,AF组患者胶原容积分数和胶原水平明显高于SR组（P<0.05）;AF组患者心房组织中FBN-1的蛋白表达水平明显高于SR组（P<0.05）;瓣膜性AF患者右心房组织FBN-1蛋白表达水平与胶原水平呈正相关关系（r=0.544,P=0.021）。结论：瓣膜性AF患者心房组织存在明显的心房纤维化,与FBN-1基因转录水平上调有关联。     

射频消融术在房颤治疗中的应用

心房颤动（atrial fibrillation,AF）是临床上常见的心律失常,且患病率随年龄增长呈逐渐上升趋势.自第一例采用射频消融术治愈房颤以来,消融技术从线性消融到肺静脉的阶段性消融、延伸的环肺静脉消融、左房的线性消融、心脏复杂碎裂电位消融、心脏神经节丛的消融等不断创新,一项新的方法在环肺静脉消融的基础上通过左房后壁来治愈房颤.射频消融在阵发性房颤患者中的成功率较高,而在持续性房颤及永久性房颤患者中效果欠佳,这些患者通过环肺静脉的消融加心房复杂碎裂电位的消融可使成功率得到极大的提高.因此,射频消融是房颤患者得到远期治愈的一种有效且确切的治疗方法.     

慢性房颤的导管消融进展

慢性房颤导管消融方法日趋成熟,包括环肺静脉消融/隔离、左心房线性消融、复杂碎裂心房电位(CFAE)消融、神经节消融、右心房消融等均有一定的效果,但尚无定式。各种方法的有机结合及个体化治疗对慢性房颤产生了更好的消融效果,成功率为21%~95%。对慢性房颤的机制及各种三维标测方法的研究、新的消融技术和能源的应用将提高消融成功率、减低复发率和手术时程;而慢性房颤导管消融的长期效果及对心脏结构功能的影响仍有待进一步探索。     

射频消融迷宫术治疗心房纤颤66例

目的 Ｃｏｘ从１９９１年采用手术切割加冷冻方法治疗心房纤颤（ＡＦ）＾（１）,但手术操作复杂,有潜在术后出血的危险性,使这一方法的使用受到一定限制,为此,我们采取措施以克服上述不足。方法 １９９５－０／１９９９－０４我们在为６例风湿性二尖瓣病患施行瓣膜置换时,采用心内直视射频消融迷宫术对其合并的ＡＦ予以治疗,６６例中男３０例,妇３６例,平均年龄４３．５万。ＡＦ病史最短１ａ,最长３０ａ,平均３４．６     

风湿性二尖瓣病变并发心房颤动患者483例临床分析

目的分析风湿性心脏病合并房颤的发病特点及各临床因素与房颤发生、发展的关系,探讨外科治疗经验。方法回顾性分析2008年3月至2009年6月我科接受二尖瓣置换手术的483例患者临床资料。男性143例,女性340例,年龄22～74(45.23±11.51)岁,其中单纯二尖瓣病变355例,二尖瓣及主动脉瓣双瓣病变128例。合并左心房血栓51例,有脑栓塞病史4例,术中同期行氩气刀心内膜消融术10例,左心房折叠术26例,行三尖瓣成形127例(其中使用人工成形环21例)。全组病例根据有无房颤及房颤持续时间分为慢性房颤组(268例)、阵发性房颤组(133例)及窦性心律组(82例),于我科标本库中随机抽取每组患者右心房组织蜡块5例,行Masson染色,观察心房纤维化情况,计算胶原容积分数。结果阵发性房颤组右心房组织胶原容积分数(14.17±1.96)显著高于窦性心律组(8.65±2.30,P<0.05),慢性房颤组(19.06±1.85)显著高于阵发性房颤组及窦性心律组(P<0.05)。手术后死亡8例,病死率1.66%,体外循环时间(90.27±46.86)min。术后二次开胸止血9例,发生瓣周漏2例,术后呼吸机辅助时间(11.20±5.87)h。10例同期接受心内膜消融术患者有8例由房颤转为窦性心律。结论风湿性心脏病二尖瓣狭窄及关闭不全促进了房颤的发生、发展,右心房纤维化程度随房颤持续时间的延长而加重。瓣膜置换术同期行迷宫手术,术后早期应用抗心律失常药物是治疗风湿性心脏病合并房颤的有效方法。     

Radiofrequency ablation of atrial tachycardia in patients with repaired atrial septal defect

Objective ： To evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia （AT） in patients with repaired atrial septal defects（ASD）. Methods： In 76 consecutive patients with AT who underwent the electrophysiological study and radiofrequency catheter ablation （RFCA）, 4 patients （one male and three female aged 35.5±11.5 years） had AT-related myocardial scar or incision. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results： Re-entry related to the lateral atriotomy scar was inducible in 3 of 4 patients. With entrainment mapping, the PPI-TCL difference was 〈30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 2 patients had successful linear ablation between scar area to inferior vena cava, and 1 patient between scar areas to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 4 patients. PPI-TCL differences 〈30 ms were found when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of incision-related AT was found during follow-up except for the failed patient. Conclusion： Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation also can be obtained in patients with IRAT related to myocardial scar or incision.     

ACEI对风湿性心脏病心房颤动患者心房ACE、ERK表达和纤维化改变的影响

目的:研究风湿性心脏病(风心病)心房颤动(房颤,AF)患者用血管紧张素转换酶抑制剂(ACEI)时心房组织血管紧张素转换酶(ACE)、细胞外信号调节激酶(ERK)表达与心房纤维化改变.方法:35例风心病二尖瓣狭窄接受外科手术患者,手术时取右心耳处心房组织400mg,通过逆转录-聚合酶链反应技术,以GAPDH为内参照,测量ACE,ERK2 mRNA变化,用Western Blotting观察ACE、磷酸化ERK(pERK)在蛋白水平表达的差异,经Masson染色研究胶原纤维容积分数(CVF)改变情况.结果:与窦性节律患者比较,慢性房颤患者在mRNA水平上ACE、ERK2表达上调,在蛋白水平上ACE、pERK表达上调(P＜0.01或P＜0.05),CVF也显著增加(P＜0.01);与未应用ACEI组比较,用ACEI组ERK2 mRNA、pERK蛋白表达下调(P＜0.05),ACE表达无差异,CVF虽有减少趋势,但无统计学意义(P＞0.05).结论:风心病慢性房颤患者较窦性节律患者ACE、ERK表达增加,纤维化加重;而在应用ACEI的慢性房颤患者,ERK2,pERK表达有显著下降,纤维化减轻,说明在房颤时,局部激活的肾素-血管紧张素系统(RAS)经ERK途径介导了心房纤维化,ACEI在一定程度上减轻心房的纤维化.     

Expression of Extracellular Signal-regulated Kinase and Angiotensin-convetting Enzyme in Human Atria during Atrial Fibrillation

Severalstudieshaveshownthatatrialfibrillation(AF)isalwayscompaniedwithchangesintheelec trophysiologicpropertiesofatrialmyocytesandalter nationsinthestructureoftheatrialtissue[1— 4 ] .Atri alfibrosisisoneoftheimportantalternationsinthestructureoftheatrial…     

不同类型心房颤动导管消融治疗的对比研究

目的探讨三维标测系统指导下对阵发性、持续性和长程持久性心房颤动(房颤)行导管消融治疗的有效性和安全性。方法选择2008年1月—2010年12月在我院行导管消融治疗的持续性及长程持久性房颤患者55例为组1,选取同期住院的阵发性房颤患者55例为组2。在CARTO或ENSITE 3000系统标测下行射频消融治疗,术中采用CARTO-Merge或Ensite Fusion图像融合技术,持续性和长程持久性房颤采用步进式消融策略,在进行环肺静脉电隔离的基础上,进一步行复杂心房碎裂电位(CFAE)或高频电位消融、对规律的房性心动过速或心房扑动(房扑)进行标测和消融,主要是线性消融,包括左房顶部线、二尖瓣环峡部线、左房间隔线和(或)三尖瓣环峡部线等其中之一或不同组合,消融至实现窦性心律,对于呈持续性房扑者经静脉推注伊布利特或直流电转复窦性心律;阵发性房颤仅行环肺静脉电隔离术。所有患者术后继续服用华法林抗凝,停服抗心律失常药物,采用门诊随访,于术后3个月、6个月随访采用动态心电图监测评价心律失常情况,术后6个月复查超声心动图评价左房直径。结果 (1)组1中17例(30.9%)消融过程中直接转复窦性心律;29例(52.7%)消融过程中房颤转变为房扑,经三维激动标测及拖带标测证实其中22例(22/29)为左房大折返房扑,余7例(7/29)为右房三尖瓣峡部依赖的典型房扑,左房房扑经静脉推注心律平或胺碘酮或伊布利特转复5例,直流电转复窦性心律15例,快速起搏拖带转复2例,7例右房房扑行三尖瓣峡部线性消融均转复窦性心律;9例(16.4%)至消融结束仍为房颤律经直流电复律。组2中18例术中发生房颤,其中13例完成环肺静脉消融后恢复窦性心律,2例采用高频刺激转复窦性心律,3例静脉推注心律平转复。(2)组1术后3个月内随访发生房性心动过速29例,不典型房扑9例,房颤13例;术后6个月房颤复发19例,一次消融成功率为65.5%。3个月内组2发生房性心动过速16例,不典型房扑8例,房颤8例;术后6个月时房颤复发7例,一次消融成功率为87.3%。两组一次消融成功率比较差异有统计学意义(P<0.01)。结论对持续性和长程持久性房颤行三维标测系统指导下射频导管消融治疗较为安全,但与阵发性房颤比较,手术时间和X线曝光时间较长,消融步骤较复杂,一次消融成功率较阵发性房颤低;消融术后发生大折返房速或不典型房扑较为常见,部分可在术后3个月减少或消失,往往需再次导管消融治疗。持续性房颤和慢性房颤射频消融治疗转复窦性心律后,左房容积减小,提示有利于心房重构的减轻或逆转。     

Catheter ablation of persistent atrial fibrillation with and without a history of paroxysmal atrial fibrillation

Background  It is unclear whether a history of paroxysmal atrial fibrillation (PAF) would impact the effect of catheter ablation on persistent atrial fibrillation (AF). This study aimed to compare the effect of catheter ablation on persistent AF with and without a history of PAF.

Methods  One hundred and eighty-three patients underwent catheter ablation of persistent AF lasting for >1 month and were reviewed. Patients were divided into two groups according to whether they had a history of PAF or not. Group I consisted of persistent AF patients with a history of PAF, and group II consisted of persistent AF patients without such a history. All patients received catheter ablation focused on pulmonary vein isolation and were observed for arrhythmia recurrences, which were defined as documented episodes of AF or atrial tachycardia after a blanking period of 3 months.

Results  One hundred and three patients (60.9%) in group I and sixty-six patients (39.1%) in group II were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between both groups except for a younger age and more male patients in group II. After (15.5±10.7) months of follow-up, 59 (57.3%) patients in group I and 49 (74.2%) patients in group II maintained sinus rhythm free of anti-arrhythmia drugs (P=0.025). Multivariate analyses found left atrial anteroposterior diameter (P=0.006) and persistent AF with a history of PAF (OR 1.792, 95% CI 1.019–3.152; P=0.043) as the only independent statistical predictors of arrhythmia recurrences.

Conclusion  The arrhythmia recurrence rate of catheter ablation based on pulmonary vein isolation in persistent AF with a history of PAF was higher than those without a history of PAF

     

心房颤动外科手术的发展与评价

随着电生理学对房颤机制的深入研究和新型标测技术消融能源的发展,房颤的外科治疗不断取得新的突破.由Cox迷宫手术的复杂术式逐渐向左迷宫、放射迷宫衍变.减少创伤提高治愈率,成为房颤外科治疗不断追求的新目标.本文概述了房颤外科治疗的各种术式设计原理和房颤根治术新消融技术的应用及其疗效评价.