Carto-Merge技术指导下肺静脉前庭电解剖隔离的初期经验

目的:介绍应用Carto-Merge技术将左心房和肺静脉CT三维重建图像与Carto电解剖标测图像相整合,指导肺静脉前庭电解剖隔离治疗心房颤动的初期经验.方法:对13例阵发性和2例持续性房颤患者,应用Carto-Merge技术进行肺静脉前庭电解剖隔离.结果:消融前左心房各壁标测点为(103±13)个;图像融合后,点与面之间的配准距离为(1.8±0.2) mm;环左肺静脉消融点(66±15)个,环右肺静脉消融点(58±20)个;所有患者均达到肺静脉电隔离;手术时间(305±45) min,透视时间(52±18) min;术中、术后无并发症发生.结论:CT三维重建后的图像接近真实解剖,与Carto电解剖标测图像的整合图像可帮助术者校正和弥补Carto电解剖图像的不足,有助于提高手术成功率,减少并发症.     

肺静脉前庭线性消融治疗阵发性心房颤动的疗效观察

目的:探讨在Carto三维电解剖标测指导下行左心房环肺静脉前庭线性消融治疗阵发性心房颤动的疗效。方法:在Carto系统中对13例入选的阵发性房颤患者建立左心房三维电解剖图,通过肺静脉造影确定肺静脉开口,围绕左、右上、下肺静脉口完成环肺静脉前庭线性消融。预设温度43℃,最大功率30W,每点消融时间大于20s。局部电位振幅降低50%以上再移动靶点,逐点完成预定消融线,以肺静脉电位完全消失并观察半小时以上仍然未恢复为消融终点。结果:所有患者均成功达到消融终点,平均操作时间为181±41min,透视时间为60±23min,放电次数120±60次。术后随访8.0±8.0个月,仅第2例在术后第3天再发房颤,但数小时自动转复为窦性心律,其后维持为窦性心律,余均为窦性心律。所有患者均无肺静脉狭窄发生。结论:三维电解剖标测指导在左心房环肺静脉前庭行线性消融治疗阵发性房颤安全有效。     

EnSite-NavX导航下射频消融大折返房性心动过速8例

目的：探讨8例大折返房性心动过速的电生理特点及射频消融策略。方法：经电生理检查确诊大折返房性心动过速8例。常规电生理检查初步确定房速所在心腔,使用EnSite-NavX三维标测系统建立靶心腔的三维构型,分析心动过速的起源点或缓慢传导区,制定相应的消融策略,使用冷盐水灌注导管消融。结果：8例患者有4例为房颤环肺静脉左房线性消融术后发作的房速,电压和激动标测显示存在瘢痕区;2例为房间隔缺损修补术后围绕右房游离壁切口瘢痕和三尖瓣环的折返性房速;另外2例为三尖瓣环折返的房速。8例患者即时消融成功,1例术后随访仍有阵发性房速发作,给予药物控制心室率治疗。结论：大折返房性心动过速的电生理机制较复杂,通过三维标测系统能阐明其机制,并有效指导消融。     

环肺静脉电隔离术与递进式个体化心房基质消融术治疗房颤结果对照

目的 观察比较环肺静脉电隔离术(CPVI)与递进式个体化心房基质消融术(SSCA)的疗效与安全性.方法 连续入选62例阵发性房颤患者,随机分为CPVI组(38例)及SSCA组(24例)；术中采用CARTO和Lasso环状标测电极导管指导消融；术后对患者定期进行体表心电图与动态心电图检查,比较两者的X线曝光时间、手术时间、未复发率等.结果 CPVI组和SSCA组的X线曝光时间分别为(33.32±6.03)min和(33.42±3.93)min,手术时间分别为(125.66±11.78)min和(131.13±10.47)min,两者对比无统计学意义(P＞0.05)；两组6个月随访时的未复发率分别为86.8％和62.5％,CPVI组高于SSCA组(x2=4.986,P＜0.05).结论 在远期未复发率方面,CPVI似乎更有优势,但还需进一步观察、随访；提高房颤治愈率的根本在于对房颤机制研究的突破.     

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?     

电解剖标测系统加单环状电极导管指导环肺静脉前庭线性消融电隔离肺静脉治疗心房颤动

目的 探讨电解剖标测系统(CARTO)加单Lasso导管指导下行环肺静脉前庭线性消融电隔离肺静脉治疗心房颤动(房颤)的初步经验. 方法 3例房颤患者接受治疗,其中阵发性房颤2例,持续性房颤1例.所有患者首先用CARTO系统进行左房重建,然后将一根Lasso导管置入肺静脉内,在肺静脉口外5～10 mm处行环肺静脉前庭线性消融,消融终点为双侧肺静脉完全电隔离. 结果 3例患者均成功达到消融终点,手术时间(205±46)min,X线透视时间(46±13)min.手术过程中无并发症发生.术后随访7个月,3例患者均未再发房颤,均无出现肺静脉狭窄. 结论 在CARTO加单Lasso导管指导下行环肺静脉前庭线性消融电隔离肺静脉治疗房颤安全有效.     

三维电解剖标测系统联合CT影像融合技术指导心房颤动环肺静脉电隔离术的临床研究

目的探讨和比较新型三维电解剖标测系统(CARTO3)及CT影像融合技术(CARTO-Merge)指导阵发性心房颤动与持续性心房颤动环肺静脉电隔离术(CPVI)的有效性和安全性。方法 52例经药物治疗无效且有房颤症状患者分为阵发性房颤组24例(A组)与持续性房颤组28例(B组)。将术前16排心脏CT扫描数据与CARTO3系统快速解剖标测重建三维解剖图形进行CARTO-Merge融合,指导CPVI,终点为消除所有肺静脉电位,未转律者行直流电复律。结果所有患者用环状标测导管Lasso建模,A组与B组间肺静脉前庭平均直径、平均手术总时间及平均冷盐水输入量差异均有统计学意义(均<0.05);两组CARTO三维消融靶点图与CT三维解剖图的平均距离、平均融合时间、平均X线曝光及消融时间差异均无统计学意义(均>0.05)。A组18例(75%)与B组14例(50%)患者消融转为窦律,两组均未发生严重并发症。结论 CARTO3及CARTO-Merge指导房颤CPVI具有较好的有效性与安全性。     

三维电解剖标测指导环肺静脉线性消融治疗阵发性心房颤动

目的 探讨在Carto三维电解剖标测指导左心房环肺静脉线性消融治疗阵发性心房颤动的疗效。方法 对2例入选的阵发性房颤患者使用Carto系统建立左心房三维电解剖图,结合肺静脉造影确定肺静脉开口,围绕左、右上、下肺静脉口完成环肺静脉线性消融。预设温度43℃,最大功率30w,每点消融时间大于20s。局部电位振幅降低50％以上再移动靶点,逐点完成预定消融线。结果 2例患者操作时间分别为181min和193min,透视时间为60min和78min,放电次数120次和136次。术后随访8个月和1个月。例2在术后第3天再发房颤,但1个月内次数较前明显减少。2例患者均无肺静脉狭窄发生。结论 三维电解剖标测指导在左心房环肺静脉线性消融治疗阵发性房颤安全有效。     

Carto系统指导下环肺静脉线性消融治疗心房颤动

目的:观察Carto系统指导下环肺静脉线性消融治疗心房颤动的临床疗效.方法:28例心房颤动(阵发性23例,持续性5例)患者行射频消融治疗.Carto系统指导下构建左心房电解剖图,行双侧环肺静脉线性消融,环状标测电极验证肺静脉达到电隔离效果.若术中心房颤动不终止,则继续消融左房顶部线、二尖瓣峡部线或三尖瓣峡部线.如心房颤动仍未终止,遂行同步直流电复律恢复至窦性心律.结果:28例患者均成功完成手术,其中18例只需完成双侧环肺静脉线性消融,10例需要继续行左房顶部线、二尖瓣峡部线或三尖瓣峡部线的消融.随访3～29个月,2例复发房颤,2例复发房性心动过速,所有患者的手术成功率为86%.结论:Carto系统指导下环肺静脉线性消融治疗心房颤动短至中期随访效果确切,具有较高成功率.     

快速解剖标测方式构建肺静脉对环肺静脉电隔离术中主要质量指标的影响

目的 探讨快速解剖标测方式构建肺静脉在环肺静脉电隔离术中应用价值.方法 收集2016年2月至2016年10月在皖南医学院弋矶山医院心内科接受导管消融治疗的60例房颤患者,依据肺静脉造影方式分为快速解剖标测组30例和非选择性肺静脉造影组30例.评价两组患者总手术时间、X线曝光时间、预定消融径线外消融点数、肺静脉隔离率等方面差异.结果快速解剖标测组与非选择性肺静脉造影组相比:曝光时间减少[(16.18±4.26)min vs(45.64±6.48)min,P<0.05],总手术时间降低[(122.34±13.82)min vs(180.19±12.56)min,P<0.05)],预定消融径线外消融点数减少[(3±1)个vs(16±4)个,P<0.05],肺静脉隔离率差异无统计学意义(96.67％vs 93.33％,P>0.05).结论 快速解剖标测方式构建肺静脉能明显提高肺静脉隔离术的手术质量.     

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.     

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     

Carto三维标测系统指导下心房颤动/扑动个体化消融原则的临床分析

目的 探讨个体化消融原则的临床效果及右房的作用.方法 房扑/房颤患者82例,男性42例,女性40例,年龄18～77(48.5±10.3)岁,左房内径26～52(35.4±5.3)mm.其中53例为阵发性房颤,14例为持续性房颤,15例为典型房扑.所有患者在Carto指导下进行个体化消融原则,以房扑/房颤被终止且不被诱发、肺静脉电位消失为消融终点.随访成功的定义为未服用抗心律失常药物、无任何症状性房性心律失常发作至少3个月.结果 ①随访时间3～28(13.4±3.3)个月,房扑和阵发性房颤消融随访成功率88.2%,持续性房颤仅为57.1%(P<0.05).2例有心包压塞,1例合并假性动脉瘤.无肺静脉狭窄等血管严重并发症.②阵发性房颤53例,其中10例为局灶性房早、短阵房速诱发的房颤(4例病灶位于右房内),8例行靶静脉线性消融,这类亚组手术无任何心律失常发作.其余43例阵发性房颤患者均行环肺静脉线性消融术,合并典型(4例)和非典型(6例)房扑者外加三/二尖瓣峡部消融.③15例典型房扑(4例为持续性房扑)患者,均行三尖瓣峡部消融,4例合并房颤者外加双侧肺静脉线性消融.④14例持续性房颤均经历了消融由房颤转变为房扑的过程,6例被消融终止和8例电复律复为窦律,半数分别进行了三/二尖瓣峡部消融和冠状静脉窦内消融,2例合并了起源于右房的房扑和房速.结论 Carto指导下房颤/房扑个体化消融可获得较好的临床疗效,右房的作用不能忽略.     

CARTO标测指导大折返性房性心动过速导管消融的临床疗效分析

目的 探讨三维标测系统指导下大折返性房性心动过速(macroreentry atrial tachycardia,MAT)电生理特征和消融效果.方法 2009年8月至2011年9月本科电生理检查确诊的MAT共计38例,年龄(48.4±10.8)岁,男性17例,女性21例,38例中15例为持续性或无休止性心动过速.合并右房明显扩大12例.常规电生理检查初步确定房速的起源心腔,在CARTO三维标测系统指导下行三维电激动和／或电压标测,确定MAT关键峡部及其基质,用冷盐水灌注导管行相应的线性消融或局灶性消融.结果 ①右房MAT共31例,27例无外科手术及消融术病史,54.8％( 17/31)为单个折返环MAT,45.2％( 14/31)合并其他类型心动过速.31例MAT均行三尖瓣峡部消融,30例消融峡部房扑终止.16例单纯消融峡部达到消融终点,另14例则同时行其他部位消融.②7例左房MAT均为导管消融术后患者,其中4例在原有的消融线上存在传导裂隙(GAP),3例为二尖瓣峡部依赖性房扑.6例消融成功.③本组消融成功率为94.7％ (36/38).随访时间2～36(18.6±4.5)个月,7例复发[复发率19.4％ (7/36)],5例再次消融成功,随访期间89.5％ (34/38)的患者无房速发作.结论 右房MAT常与三尖瓣峡部和自发性瘢痕有关,而左房MAT多与手术损伤有关,三维标测有助于提高复杂心律失常的消融成功率.     

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.     

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。     

Impact of the origin of sinus node artery on recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Background  Major atrial coronary arteries, including the sinus node artery (SNA), were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof. The SNA is a major atrial coronary artery of the atrial coronary circulation. This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF.

Methods  Seventy-eight patients underwent coronary angiography for suspected coronary heart disease, followed by catheter ablation for paroxysmal AF. According to the origin of SNA from angiographic findings, they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery). Guided by an electroanatomic mapping system, circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint. All patients were followed up at 1, 3, 6, 9 and 12 months post-ablation. Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs), including AF, atrial flutter or atrial tachycardia, that lasted longer than 30 seconds after a blanking period of 3 months.

Results  The SNA originated from the right coronary artery in 34 patients (43.6%) and the left circumflex artery in 44 patients (56.4%). Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9 % (53/78) for all patients. After 1 year follow-up, 79.4% (27/34) in right SNA group and 59.1% (26/44) in left SNA group (P=0.042) were in sinus rhythm. On multivariate analysis, left atrium size (HR=1.451, 95%CI: 1.240–1.697, P <0.001) and a left SNA (HR=6.22, 95%CI: 2.01–19.25, P=0.002) were the independent predictors of AF recurrence.

Conclusions  The left SNA is more frequent in the patients with paroxysmal AF. After one year follow-up, the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in paroxysmal AF.

     

Mechanisms of organized atrial tachycardia during catheter ablation of chronic atrial fibrillation by stepwise approach

Background Extensive atrial fibrillation （AF） ablation is associated with an increased success rate of catheter ablation in chronic AF patients and an increased rate of atrial tachycardia （AT） during the procedure. The mechanism of these Ats varies in previous studies. Our study aimed to report the mechanism of organized AT occurring during the stepwise ablation procedure of chronic AF.Methods A prospective cohort of 86 consecutive patients who underwent an ablation procedure for chronic atrial fibrillation （CAF） was investigated. The stepwise procedure was performed in the following order： circumferential pulmonary vein ablation, complex fractionated atrial electrograms ablation, mapping and ablation of AT. The endpoint was noninducibility of AF/AT after sinus rhythm （SR） was restored or the procedure time was beyond 6 hours.Results Sixty-nine （80%） of patients converted to SR via AT. A total of 179 sustained ATs were observed in 69 patients during the procedure. There were 81% （n=145） macroreentrant ATs which included 65 perimitral circuits, 48 peritricuspid tachycardia and 32 roof dependent circuits, 12% （n=21） localized reentrant and 7% （n=13） focal ATs. Thirty （15%） patients experienced significant left atrium （LA） and LA appendage （LAA） conduction delay or dissociation in the procedure or during the follow-up period.Conclusions Most CAF patients converted to SR via ablation of organized AT occurring during the stepwise procedure. The mechanism of most of these ATs was macro-reentry.     

非接触心内膜激动标测系统指导疑难心律失常消融的临床研究

目的 研究非接触心内膜激动标测系统指导疑难心律失常的标测与消融的有效性与优越性。方法 12例患者，男性9例，女性3例，年龄28-76岁，电生理检查为右室特发性室性早搏1例，左室特发性室性心动过速2例，左房房性心动过速1例，右房房性心动过速2例，左房心房颤动6例．其中4例常规电生理标测消融末成功，1例成功后复发．经股静脉置入64极球囊电极和射频消融导管至同一心腔．计算机标测系统首先构建心腔几何构型，然后建立心动过速的腔内等电势图，分析心动过速的起源点及关键峡部，利用计算机导航系统指导消融导管至拟定靶点处进行消融，结果 1例起源于右室流出道偏间隔的室性早搏患者行片状消融获得成功；2例左室特发性室性心动过速标测其心动过速起源于左后中间隔及左后间隔区域行片状消融成功；1例左房房性心动过速标测其心动过速起源于右肺下静脉间隔部并指引消融导管行右肺下静脉至二尖瓣之间线性消融获得成功；2例右房房性心动过速巾1例标测其最早激动点位于下腔静脉口，此处行环状消融获得成功，另1例位于上腔静脉后方穿过界嵴中部线性消融获得成功；6例左房房颤患者1例在窦性心律卜标测其敛房颤房早起源于左右上肺静脉之间，行线性消融成功，另5例在房颤发作下标测其房颤起源折返部位，分别行右上下肺静脉、左上下肺静脉、左右上肺静脉之间、左下肺静脉与二尖瓣峡部之间线件消融成功，12例患者术中、术后均无并发症，随访2—26个月，无1例复发．结论 非接触心内膜激动标测系统指导心律失常的心内膜标测与消融是安全有效的，对复杂、难治性心律失常的电生理机制的阐明和指导消融具有较好的临床应用价值，     

血浆NT—pro-BNP和左房内径对房颤导管射频消融术后复发的评估价值

目的：探讨术前血浆NT-pro-BNP和术前超声心动图左房内径对环肺静脉消融术治疗房颤术后复发的相关性,以提高房颤射频消融手术的成功率。方法70例行环肺静脉消融术的房颤患者,在术前检测血浆NT-pro-BNP,经胸超声心动图测量左房内径,经食道超声心动图了解有无左房内血栓形成。15例有左房内血栓形成者未行环肺静脉消融术,余下55例均成功行环肺静脉消融术。术后随诊,每月复查心电图,动态心电图了解有无房颤的复发。3月后仍有房颤发生则认为手术失败。成功组39例、失败组16例。结果69%患者NT-pro-BNP高于正常范围。消融失败组NT-pro-BNP明显高于成功组,失败组左房内径明显大于成功组。结论对于NT-pro-BNP明显增高且左房内径又明显增大者行环肺静脉消融术治疗房颤则复发的可能性明显增加,可将术前NT-pro-BNP及左房内径作为房颤术前筛选患者的参考指标。