HD-Grid高密度标测导管在阵发性心房颤动消融术后复发患者中的应用

目的 应用高密度标测导管HD-Grid(HDG),准确识别肺静脉再连接,降低心房颤动(简称房颤)导管消融后复发率。方法 从2020年1月至2021年1月,连续入选30例因阵发性房颤行射频消融手术,术后房颤复发患者,分别使用环肺电极和HDG进行左房电解剖标测,比较两组间识别出肺静脉再连接的差异,并以此指导再次肺静脉隔离,观察远期房颤复发率。结果 30例患者年龄(68.00±8.25)岁,男18例,女12例。应用HDG标测,24例发现了72处肺静脉再连接,应用环肺电极,仅在12例患者中发现了24处肺静脉再连接。与环肺电极相比,HDG可以识别出更多的肺静脉再连接位点数[3(2,4)vs 0.8(0.4,1.0),P<0.05]。30例在HDG指导下再次肺静脉隔离后,在12个月随访时间内,5例再次出现房颤复发,其中能够识别到肺静脉再连接者,仅1例出现房颤复发。结论 HDG能帮助识别出更多的肺静脉再连接,以其指导肺静脉隔离,降低房颤复发的概率。     

高密度标测指导下射频导管消融房性心动过速

目的 探讨EnSite NavX系统高密度标测对房性心动过速（房速）射频导管消融的指导作用.方法 17例房速患者,平均年龄（45.9±16.9）岁,男性15例,女性2例.心动过速均呈持续性发作,应用EnSite NavX系统于心房进行高密度标测,建立激动图.对于折返性房速,线性消融关键峡部或传导通道（channel）,对于局灶性房速,点消融局部最早心房激动区域.结果 17例患者中,共标测到19种房速,周长为（254±49）ms,平均取点（316±90）个,标测时间为（8.4±2.6）min,建立19种激动图 激动图显示大折返性房速10种,局灶性房速9种 19种房速中,18种即时消融成功 无标测与消融相关并发症发生.随访（3.0±1.6）个月,2例服用胺碘酮可预防发作（1例患者房速复发,1例患者术中有1种房速未消融成功）.结论 EnSite NavX系统高密度标测对心动过速机制可作出快速、准确的判断,有助于确定消融靶点,提高消融成功率.     

三维引导下多极高密度标测在右室流出道室性早搏消融中的应用

目的评价多极接触标测在指导三维电解剖引导下右室流出道(RVOT)室性早搏(简称室早)消融的疗效。方法选择32例RVOT室早患者,据术中室早发作的频度分为两组:室早1次/分者采用多极导管高密度标测(多极组);室早≥1次/分者采用单导管逐点标测(单极组);确定激动起源靶点后再进行起搏标测证实并实施消融治疗。比较两组的标测时间、消融次数及时间、X线曝光时间、消融成功率。结果 29例患者完成电生理标测及消融,单极组16例,多极组13例。多极组平均采集有效标测点明显多于单极组;激动顺序标测耗时两组未见差异。多极组总手术时间明显长于单极组,但是在平均消融次数、消融时间、X线透视时间等指标比较,多极组却显著少于单极组,所有患者均达到即刻消融终点。随访(6.9±3.2)个月,单极组1例复发。结论采用多极标测导管对RVOT局部进行高密度电解剖标测快捷、精确,提高消融成功率,尤其是对术中室早发作较少的患者。     

拖带标测融合高密度标测成功治疗复杂房性心动过速一例

患者64岁,女性,因晕厥原因待查入院,心电图提示房性心动过速(简称房速),利用Pentary在CartoV6系统指导下行激动标测,标测后提示右房折返相关房速,高密度电压标测提示右房游离壁瘢痕,利用拖带标测并进行图像融合后精确定位折返环,放电一次即终止房速,术后未再诱发心动过速.     

磁导航技术结合CARTO指导下持续性心房颤动的导管消融一例

患者男性,4l岁,因心悸反复发作3年加重1月,心电图提示持续性心房颤动行射频消融术,采用磁导航技术结合CARTO三维标测系统,先构建左房几何三维模型,行双侧肺静脉消融至电学隔离,而后行三尖瓣峡部线性消融,随后电复律恢复成窦性节律,验证肺静脉电位未恢复,三尖瓣峡部线双向阻滞。术后随访2.5年无心房颤动、房性心动过速发生。     

内外科杂交消融可能是治疗持续性心房颤动的较好选择

对于持续性心房颤动(AF),目前尚没有统一的消融策略。导管室的内科消融不管采取何种策略,消融成功率低。Cox外科迷宫手术治疗持续性AF成功率达95%,但创伤大,医患均难以接受。微创迷宫手术为外科消融治疗持续性AF提供了可接受的途径和机会。内外科消融可互相补充,克服各自的优缺点。内外科杂交消融有两种模式,一种是同时进行;另一种为先后进行,可根据病情采用不同的模式。内外科杂交消融可能是治疗持续性AF的较好选择。     

常规电生理标测法射频消融治疗房性早搏

目的探讨导管消融治疗房性早搏(PACs)的临床疗效。方法 10例PACs病人,Holter提示24 h PACs17 957.2±4 532个,4例伴有短阵房性心动过速,根据心内激动顺序,初步确定感兴趣区域,应用激动标测法进行标测,在相对最提前部位消融,采用标准为提前≥30 ms。结果手术时间1.6±0.6 h,X线曝光时间21.6±5.4min。每例病人消融2.8±0.8(2～5)次。术后第3日Holter检查,5例病人PACs完全消失,3例病人PACs在2～12个之间,2例病人PACs分别为307及204个,此2例术前均为双源性PACs,残余均为另外一种形态的PACs。随访9.3±4.2个月,无1例复发。结论导管消融治疗PACs是安全和有效的。     

环肺静脉前庭隔离术终止持续性心房颤动的临床预测因素

目的探讨持续性心房颤动(简称房颤)经环肺静脉前庭隔离术(CPVAI)术中终止的临床预测因素。方法 85例在三维电解剖标测系统(CARTO)指导下首次接受CPVAI治疗的持续性房颤患者。消融在房颤心律下进行,终点为肺静脉前庭电隔离。对术中房颤经消融终止及未终止者20项临床指标进行分析,确立对术中房颤经消融终止具有预测价值的指标。结果所有患者均实现消融终点。术中房颤经消融终止者28例(32.9%),其中12例直接恢复为窦性心律,16例转为房性心动过速,57例CPVAI后仍为房颤。单因素分析结果显示:房颤持续时间、既往有阵发性房颤病史、短病程(1年)持续性房颤、阵发性房颤病史+短病程持续性房颤是预测术中房颤经消融终止的指标,但经多因素分析后仅有阵发性房颤病史+短病程持续性房颤是预测术中房颤经消融终止的指标(P0.001;RR∶0.100;95%C I∶0.033~0.307)。结论由阵发性房颤进展而来的短病程持续性房颤是CPVAI术中房颤经消融终止的独立预测指标。     

国产ColumbusTM三维标测系统在心房颤动射频消融中的初步应用

目的报道国产ColumbusTM三维电解剖标测系统在射频消融治疗持续性心房颤动（简称房颤）中的初步应用经验。方法2012年3月至2013年4月入选持续性房颤患者10例作为实验组,术中两次穿刺房间隔成功后送入环形标测电极和冷盐水灌注消融电极导管,使用Columbus系统构建左房和肺静脉电解剖结构后行房颤消融。另取10例使用CaaoXP系统辅助消融的持续性房颤患者作为对照组。结果实验组和对照组患者术中均成功完成肺静脉电隔离和必的线性消融。与对照组相比,实验组建模时间、X线曝光时间和放电时间无显著性差异[分别为（11±4）minVS（9±4）min;（13±3）minVS（4±5）min;（35±8）minVS（33±9）min,P均〉0．05]。实验组总手术时间长于对照组[（135±20）minvs（120±17）min,P〈O．05]。两组在术中、术后均没有严重并发症出现。在术后至少1年的随访时间中,实验组和对照组分别有4例和5例患者复发。结论国产Columbus三维标测可安全有效地指导房颤的射频消融手术。     

持续性心房纤颤的辅助消融策略

心房纤颤（简称房颤）是一种临床上最常见的持续性心律失常,发病率高,危害大。近年来,房颤的非药物治疗取得了较快发展,其中肺静脉隔离（PVI）就是一种有效的治疗方法。这种方法对于阵发性房颤患者治愈率较高,而在持续性房颤和长时程房颤患者中疗效一般。本综述主要探讨针对持续性房颤患者的最新辅助消融策略及其机制,包括线性消融、复杂碎裂心房电位（CFAE）消融、神经节（丛）消融、主频率消融、转子消融和与房颤触发相关的其他解剖位点消融。     

Termination of persistent atrial fibrillation during left atrial mapping

Termination of Persistent AF During Mapping. Complex fractionated atrial electrograms (CFAEs) may represent critical areas for the maintenance of atrial fibrillation (AF). While AF organization and termination have been reported with CFAE ablation, no reports of arrhythmia termination during left atrial mapping exist. We report a case of reproducible AF termination with catheter pressure at a site of CFAE remote from the site of AF. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1171‐1173, October 2011)     

Tachycardia transition during ablation of persistent atrial fibrillation

Tachycardia Transition . Background: The “sequential ablation” strategy for persistent AF is aimed at progressive organization of AF until the rhythm converts to sinus rhythm or atrial tachycardia (AT). During ablation of an AT, apparently seamless transitions from one organized AT to another occur. The purpose of our study was to quantify the occurrence and the mechanism of this transition. Methods and Results: Twenty‐nine of 90 patients undergoing ablation for persistent AF had multiple AT during the procedure and constitute the study group. Thirty‐nine direct transitions from one AT to another during ablation were observed classified in four types: type I (79.4%), i.e., a direct transition of a faster to a slower tachycardia without significant intervening pause; type II (7.69%)—transition after intervening ectopy or longer pause; type III (10.26%)—A slower AT accelerated; type IV (2.56%)—alteration of activation sequence but with no change on CL. Conclusions: Transition to a second AT occurs frequently in the midst of ablation of AT in persistent AF patients. This transition occurs most commonly abruptly within the range of a single cycle length of the original AT. This is best explained by a continuation of AT that was “present” simultaneously with the pretransition tachycardia, being “entrained” (for a reentrant tachycardia) or “overdriven” for an automatic focal tachycardia. The presence of multiple tachycardia mechanisms active simultaneously would be consistent with the eclectic pathophysiology of persistent AF. (J Cardiovasc Electrophysiol, Vol. 22, pp. 506‐512 May 2011)     

Ablation of persistent atrial fibrillation based on high density voltage mapping and complex fractionated atrial electrograms: A randomized controlled trial

Introduction:Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, a PVI alone has been considered insufficient for persistent AF. This study aimed to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones identified by high-resolution mapping in addition to the PVI.Methods:We randomized 50 patients (mean age 58.4 ± 9.5 years old, 86.0% males) with persistent AF to a PVI + CFAE group and PVI only group in a 1:1 ratio. CFAE and voltage mapping was performed simultaneously using a Pentaray Catheter with the CARTO3 CONFIDENSE module (Biosense Webster, CA, USA). The PVI + CFAE group, in addition to the PVI, underwent ablation targeting low voltage areas (<0.5 mV during AF) containing CFAEs.Results:The mean persistent AF duration was 24.0 ± 23.1 months and mean left atrial dimension 4.9 ± 0.5 cm. In the PVI + CFAE group, AF converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group had a higher 1-year AF free survival (84.0% PVI + CFAE vs 44.0 PVI only, P = .006) without antiarrhythmic drugs. However, there was no difference in the AF/AT free survival (60.0% PVI + CFAE vs 40.0% PVI only, P = .329).Conclusion:Persistent AF ablation targeting CFAE areas within low voltage zones using high-density voltage mapping had a higher AF free survival than a PVI only. Although recurrence with AT was frequent in the PVI+CFAE group, the sinus rhythm maintenance rate after redo procedures was 76%.     

Results of complex left atrial ablation of long-lasting persistent atrial fibrillation

PURPOSE: The aim of the study was to identify variables associated with successful long-term maintenance of sinus rhythm (SR) after a single ablation of long-lasting persistent atrial fibrillation (AF). METHODS: Complex left atrial (LA) ablation was performed in 100 patients. Restoration of SR by ablation was the desired procedure endpoint. RESULTS: SR was restored by ablation in 38 patients during the first procedure. Following one ablation, 50 patients remained in SR for 31 +/- 14 months. SR maintenance was associated with shorter duration of the persistent AF (median 14 vs. 22 months; P = 0.05), lower proportion of the LA points exhibiting voltage <0.2 mV (median 20% vs. 33%; P = 0.006), and higher proportion of LA points showing voltage >1 mV (median 15% vs. 11%; P = 0.02). CONCLUSION: Among clinical variables, shorter duration of persistent AF and higher voltage recorded around the LA predicted long-term maintenance of SR after single ablation.     

Beyond pulmonary vein isolation for persistent atrial fibrillation: sequential high-resolution mapping to guide ablation

Journal of Interventional Cardiac Electrophysiology - We aimed to evaluate whether outcomes with ablation in persistent (PsAF) and long-standing persistent (LsPsAF) AF can be improved beyond what...