环肺静脉前庭隔离治疗阵发性心房颤动两种手术方法的临床对比研究

目的 比较环肺静脉电极指引下的肺静脉前庭导管消融与单导管技术隔离肺静脉前庭对阵发性心房颤动（房颤）治疗方法学和疗效的差异.方法 2010年9月至2013年9月共有135例阵发性房颤患者在北京同仁医院接受导管消融治疗,分为环肺电极组54例和单导管消融组81例,行三维标测系统（CARTO）下房颤导管消融.行双侧肺静脉前庭隔离后,比较两组的安全性、时效性和临床效果.结果 环肺电极组肺静脉前庭隔离52例（96.3％）,单导管消融组78例（96.3％）,两组隔离率比较,差异无统计学意义（P＞0.05）.在手术操作时间上,单导管消融组明显快于环肺电极组[（76±41） min比（101±32） min,P＜0.05].单导管消融组X线曝光时间明显少于环肺电极组[（12±6.1） min比（24±6.5） min,P＜0.05].随访8个月,不使用抗心律失常药物成功维持窦性心律的患者,环肺电极组43例（79.6％）,单导管消融组67例（82.7％）,两组差异无统计学意义（P＞0.05）;环肺电极组有2例肺静脉缩窄的并发症.结论 对于阵发性房颤的消融,单导管消融优于环肺静脉电极指引下导管消融,应用单导管技术定位缝隙实现肺静脉前庭的完全隔离安全有效.     

经导管射频消融治疗阵发性心房颤动的疗效和安全性

目的 探讨经导管射频消融治疗阵发性心房颤动(简称房颤)的有效性与安全性.方法 42例阵发性房颤患者采用节段性消融肺静脉电隔离术或三维标测系统指导下环肺静脉电隔离术两种不同方法进行经导管射频消融治疗,术后进行随访,观察其疗效和安全性.结果 42例患者中,25例(59.52%)经导管消融成功.4例(9.52%)有效,13例(30.95%)无效,4例(9.52%)出现并发症,无死亡病例.节段性消融肺静脉电隔离术平均手术时间为(235.50±38.01)min,X曝光时间为(74.35±12.73)min;三维标测系统指导下环肺静脉电隔离平均手术时间为(163.18±24.76)min,X曝光时间为(36.90±8.06)min.结论 经导管射频消融治疗阵发性房颤对大部分患者是有效的,三维标测系统指导下环肺静脉电隔离术的手术时间和X曝光时间短于节段性消融肺静脉电隔离术.     

环单侧靶肺静脉-前庭射频消融治疗心房颤动

目的 Carto系统指导下对心房颤动（房颤）相关的靶肺静脉进行环同侧上、下肺静脉-前庭单环线性消融隔离,观察疗效.方法 对25例术中反复自发肺静脉相关房性早搏（房早）,并触发房性心动过速（房速）和/或房颤的患者,在Carto系统结合单Lasso环状标测导管指导下进行环靶肺静脉-前庭单环射频消融术,达到肺静脉隔离.结果 消融过程中25例患者房早、房速、房颤终止,其中19例患者有自发的肺静脉电位,15例慢于窦性心率.4例患者隔离后肺静脉内发生房颤或房速,2例在肺静脉内补点消融后肺静脉电位消失.随访（22.24±9.01）个月,23例无房速、房颤发作,2例患者术后复发房颤,1例接受再次手术,术后房颤发作减少,1例口服胺碘酮控制.结论 术中能够明确靶肺静脉、单个触发灶的房颤患者,在Carto系统结合单Lasso导管指导下行单环线性消融隔离治疗房颤,成功率高、复发率低,可减少手术损伤.     

老年心房颤动不同方式的经导管射频消融治疗

目的研究不同方式经导管射频消融治疗对老年房颤的治疗效果。方法53例房颤患者，男性38例，女性15例，年龄60-83岁。按接受不同的经导管消融方法将上述患者分为3组：消融隔离肺静脉治疗阵发性房颤组20例、消融典型房扑治疗房颤合并房扑组26例、消融房室传导加植入永久性起搏器治疗持续性房颤伴药物难以控制的快速心室率和（或）心力衰竭组7例。结果消融隔离肺静脉组中15例采用环状标测电极导管引导电隔离3～4根肺静脉成功，术后无房颤发作8例（53％），房颤发作明显减少4例（27％）；采用电解剖系统引导下环双侧肺静脉线性消融隔离肺静脉5例，无房颤发作4例（80％）。消融房扑组26例典型房扑均消融成功，随访中15例（58％）无房颤发作，8例（31％）房颤发作较前减少。经导管消融房室传导组7例全部成功，4例行右心室、3例行双心室VVI模式起搏，随访中生活质量和（或）心力衰竭症状明显改善。结论针对不同类型的老年房颤患者采用不同的经导管消融方法可以取得较好的临床效果。     

环状电极在Ensite/NavX指导下的心房颤动环肺静脉消融术中的应用

目的评价环肺静脉消融术联合应用环状电极标测对心房颤动(房颤)消融成功率的影响。方法连续入选61例房颤患者,其中男40例,女21例,阵发性房颤50例,慢性房颤11例。在EnsiteNavX三维电解剖标测系统指导下行环肺静脉消融术。应用环状电极标测肺静脉电位,以肺静脉电隔离为消融终点。结果61例均顺利完成手术。环左肺静脉消融使左肺静脉电隔离34例(55.7%),环右肺静脉消融使右肺静脉电隔离35例(57.4%),环左、右肺静脉消融使所有肺静脉电隔离23例(37.7%)。16例阵发性房颤和5例慢性房颤放电时终止房颤,终止房颤部位为左、右上肺静脉外近房顶前、后壁19例,右上肺静脉外后壁中部1例,完成左肺静脉消融时房颤终止1例。平均随访6±2个月,50例阵发性房颤中42例(84.0%)以及11例慢性房颤中5例(45.4%)无房颤发作,总成功率为77%。并发症:少量心包积液1例,经心包穿刺引流后积液消失;左侧血胸1例,经胸腔穿刺引流痊愈。结论EnsiteNavX系统指导下的环肺静脉消融术中联合应用环状电极标测可使房颤消融成功率进一步提高。     

消融导管近远端激动间距定位左房-肺静脉电位传导缝隙的价值

目的探讨阵发性心房颤动（简称房颤）环肺静脉前庭电隔离（CPVI）术中,标测消融导管近远端激动间距（ABLp-d AI）是否有助于定位初始环状消融线上的左房-肺静脉电位传导缝隙（gap）。方法 56例阵发性房颤患者,在EnSite NavX三维标测系统指导下行环同侧肺静脉前庭的线性消融和gap补充消融以达全部肺静脉电隔离。回顾分析窦性心律下两侧环线上178个补充消融点的局部心内电图,根据术中补充消融结果,将其分为有效组（gap）与无效组（非gap）,比较两组间ABLp-d AI有无差异。结果有效组ABLp-d AI明显短于无效组[（28.75±19.74）ms vs（43.39±23.62）ms,P〈0.05];ROC曲线分析显示,ABLp-d AI的曲线下面积是0.924,对于定位gap的最佳诊断阈值为25 ms,其对应的灵敏度、特异度、阳性预测价值和阴性预测价值分别为：88.2%、87.3%,、78.1%、92.9%。结论 CPVI术中,标测ABLp-d AI有助于准确定位初始环状消融线上的gap,提高阵发性房颤消融的效率。     

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。     

环肺静脉电隔离术后房性快速心律失常的机制和再消融治疗

目的分析环肺静脉电隔离术后，房性快速心律失常（ATa）发生机制和再次消融治疗结果。方法采用Lasso导管和电解剖（Carto）标测，对135例房颤患者行环同侧肺静脉电隔离消融术。术后随访时间3个月以上的102例患者中，33例患者仍有ATa发作。其中20例接受再次消融治疗。再次消融术均采用单Lasso导管标测，Carto指导下点状消融肺静脉与心房的传导点（gap），或环肺静脉线性消融左心房。消融成功终点为双侧肺静脉电隔离。结果Lasso导管标测表明，20例患者均存在心房与肺静脉（A—PVP）的电传导，一侧和双侧A—PVP传导分别为8例和12例。再次消融，18例患者达到肺静脉电隔离（其中10例为局部补点式消融，余8例行环肺静脉线性消融）。另2例患者的左侧或双侧肺静脉未能电隔离。平均随访（5．5±5．3）个月，18例术中达到消融终点的患者，仅1例仍有阵发性房颤。结论环肺静脉线性消融术后，存在或恢复左心房与肺静脉的电传导是导致ATa发生的主要原因。再次消融电隔离肺静脉是成功治疗的关键。     

未成年患者心房颤动的发生机制及导管消融(附二例报道)

目的探讨未成年患者心房颤动(简称房颤)的发生机制及导管消融疗效。方法采用三维电解剖标测及环状电极记录肺静脉电位的方法,对2例年龄小于18岁房颤患者进行环肺静脉消融。结果例1为阵发性房颤示左肺静脉起源,成功隔离左肺静脉。例2持续性房颤患者在行两肺静脉电隔离过程中冠状静脉窦心房波频率渐渐减慢,在完成两肺电隔离后房颤终止,分别随访3.5,1个月,无房颤复发。结论2例未成年患者房颤均起源肺静脉,射频消融效果好。     

导管射频消融电隔离心脏大静脉治疗阵发性心房颤动的并发症分析

目的总结导管射频消融电隔离肺静脉和(或)上腔静脉(大静脉)治疗阵发性房颤的并发症与合并症. 方法顽固性阵发性房颤患者89例,在环状标测电极指导下行大静脉的导管射频消融电隔离治疗,如能确定触发房颤的靶大静脉,则行靶大静脉的电隔离,如不能确定靶肺静脉,则经验性地行主要肺静脉(双上肺静脉和左下肺静脉)的电隔离,术后重复肺静脉造影.     

Safe and Rapid Isolation of Pulmonary Veins Using a Novel Circular Ablation Catheter and Duty-Cycled RF Generator

Background: Ablation of atrial fibrillation (AF) has been one of the most difficult and time-consuming electrophysiological procedures. Due to the rapidly increasing demand for ablation procedures, technical advances would be helpful to reduce complexity and procedure time in AF ablation. Therefore, we investigated the feasibility of a single-catheter technique for pulmonary vein (PV) isolation utilizing a decapolar catheter combined with a duty-cycled, unipolar–bipolar radiofrequency (RF) generator.
Methods: AF mapping and ablation was performed in 21 consecutive patients (mean age 59 ± 12 years, 9 males) with paroxysmal AF (n = 17) and persistent AF (n = 4). The ablation catheter was forwarded to the LA via single-transseptal puncture. All electrodes were energized in 2 to 5 applications per vein, followed by segmental RF applications, as needed, to achieve electrical isolation. To assess left atrial anatomy for purposes of catheter manipulation, and later evaluate the possibility of asymptomatic PV-stenosis, CT or MR imaging was performed both prior to ablation and at 6-month follow-up.
Results: Isolation could be achieved in 85/86 veins (99%). Procedure time for ablation was 81 ± 13 minutes, and fluoroscopy time was 30 ± 11 minutes. There were no procedural complications. Success rate at 6 months was 86% (18/21). MR or CT imaging excluded asymptomatic PV-stenosis.
Conclusion: Mapping and ablation of PVs can be performed in a safe and efficient manner using a single-catheter technique, with short procedure times and minimal learning curve. Thus, this system may be of high interest not only for high volume but all centers performing AF ablation.     

冷冻球囊导管消融治疗心房颤动的学习曲线分析

目的：探讨应用冷冻球囊导管消融术（ CBCA）行初次肺静脉电隔离（ PVI）治疗心房颤动（房颤）的学习曲线、即刻有效性及安全性。方法分析2013年12月11日至2014年2月28日由单一术者利用CBCA行初次PVI治疗的连续20例房颤患者的资料。将病例按手术先后编号,观察手术时间及X线透视时间变化。并将病例分为2组（前10例：A组,后10例：B组）,比较两组的手术时间、X线透视时间及即刻PVI的成功率的差异。结果20例患者[男12例,平均年龄（55．4±11．6）岁,阵发性房颤19例、持续性房颤1例）房颤病程的中位数为24个月。 A、B两组平均冷冻次数[（10．5±2．1）次对（9．3±1．7）次,P=0．180]差异无统计学意义。与A组相比,B组平均冷冻时间[（46．5±11．4）min 对（36．7±4．4）min, P=0．021]、手术时间[（150．0±27．6）min对（123．4±19．8）min, P=0．023]及X线透视时间[（62．5±15．7）min对（47．2±9．7）min, P=0．018]均减少。单纯行CBCA治疗,B组在患者水平及肺静脉水平上达到即刻PVI的成功率较A组高（ P＜0．05）。围术期出现1例（5%）主要并发症为膈神经麻痹（ PNP）。结论应用CBCA行PVI治疗房颤具有近期安全性和即刻有效性。术者可以通过较少病例很快完成学习曲线。 PNP作为主要并发症值得注意。     

递进式消融法治疗持续性心房颤动的初步体会

目的评价一种递进式消融法治疗持续性心房颤动（房颤）的疗效。方法34例持续性房颤患者,年龄（54．8±11．4）岁,病程（36．5±9．8）个月。按以下顺序进行递进式消融：环肺静脉前庭消融达肺静脉电学隔离,左心房顶部和二尖瓣环峡部线性消融,心房碎裂电位消融,针对房颤转变的心房扑动（房扑）／房性心动过速（房速）行Carto激动标测结合拖带技术以明确其机制,并力求通过消融终止。结果递进式消融法使88．2％患者房颤节律发生变化（直接终止或转变为房扑／房速）,61．8％直接通过消融恢复窦性心律。随访（12．6±6．2）个月,82．4％患者维持窦性心律（其中42．9％服用胺碘酮）。结论递进式消融是治疗持续性房颤的一种有效方案。     

Initial experience with robotic navigation for catheter ablation of paroxysmal and persistent atrial fibrillation

Background and PurposeRemote robotic navigation (RRN) technology has been developed to facilitate catheter ablation of symptomatic atrial fibrillation (AF). Here, we assess procedural parameters of AF ablation obtained during initial use of RRN compared with a control group treated with a manual ablation approach.MethodsConsecutive patients with symptomatic paroxysmal or persistent AF were subjected to radiofrequency catheter ablation with RRN (Sensei X [Hansen Medical, Mountain View, CA]; n = 25; mean age, 60 ± 2.3 years) or using the standard manual technique (n = 61; mean age, 62 ± 1.4 years). A circumferential pulmonary vein isolation approach guided by 3-dimensional electroanatomical mapping was followed.ResultsRemote robotic navigation was associated with reduction of overall fluoroscopy time by 26%. In a case-control subgroup analysis comparing 25 patients with similar clinical characteristics from each group, mean fluoroscopy time was reduced by 22%. Acute isolation of pulmonary veins was achieved in 97% (RRN) and 96% (conventional ablation), respectively. Ablation times and frequency of adverse events were not significantly different among study groups.ConclusionsThe early use of RRN resulted in a significant reduction of overall fluoroscopy time and was equally effective and safe compared with manual catheter ablation.     

Single‐Catheter Technique for Pulmonary Vein Antrum Isolation: Is It Sufficient to Identify and Close the Residual Gaps Without a Circular Mapping Catheter?

Objectives: The present study was designed to investigate the feasibility and efficacy of single ablation catheter for complete circumferential pulmonary vein antrum (PVA) isolation.
Background: Complete isolation of pulmonary veins is the mainstay for atrial fibrillation (AF) ablation. This is usually performed under the guidance of a circular catheter.
Methods: One hundred and ten consecutive patients with paroxysmal AF were prospectively randomized into two groups: single-catheter approach (group 1) and double-catheter approach (group 2). After performing initial circumferential lesions, residual gaps were mapped and closed with single ablation catheter in group 1 or guided by a circular mapping catheter in group 2 using an electroanatomic mapping system (CARTO™ XP, Biosense-Webster Inc., Diamond Bar, CA, USA).
Results: Complete bilateral PVA isolation was achieved in 22 of the 110 patients after initial ablation. All residual gaps could be correctly identified by activation mapping using single ablation catheter. The distribution of these residual gaps was asymmetric. In group 1, 25 gaps along the right PVA lesions and 49 gaps along the left PVA lesions were identified. All the residual gaps were closed with single-catheter approach. In group 2, 28 gaps on the right side and 53 gaps on the left side were identified using a circular catheter and closed with further ablations. The procedure data and clinical outcomes between the two groups were comparable.
Conclusions: Single ablation catheter technique is feasible and as effective as circular catheter mapping in localizing the residual gaps for PVA isolation during ablation of paroxysmal AF.     

单导管实施三维电解剖标测与消融治疗流出道室性心律失常

目的探讨使用单导管技术实施三维电解剖标测和消融治疗流出道室性心律失常。方法78例住院患者（男34例,女44例）,平均年龄（41±11）岁。采用Carto及单一专用导管行电解剖重建、激动顺序标测、起搏与拖带或基质标测,实施射频消融。部分病例与多排CT心脏影像融合显示,观察即刻成功率、消融成功靶点的分布、并发症,随访复发情况。结果共75例完成消融,73例采用单导管技术,即刻成功71例。成功消融部位：右心室流出道间隔部33例,游离壁18例,肺动脉瓣上5例,左心室流出道4例,左冠窦7例,右冠窦4例。操作时间（62±25）min,X线曝光时间（12±8）min。3例消融术中出现右束支阻滞,2例术后恢复,未见其他并发症。随访复发2例,1例再次消融成功,1例症状减轻未再消融。结论用单导管实施三维电解剖标测与消融治疗流出道室性心律失常,安全、有效、操作简单。     

Ablation of superior pulmonary veins compared to ablation of all four pulmonary veins:

INTRODUCTION: Isolation of all pulmonary veins (PV) is advocated for treatment of paroxysmal atrial fibrillation (PAF). However, the superior PVs are responsible for most AF triggers, whereas the inferior PVs carry the higher risk for ablation-induced ostial stenosis. The aim of this study was to compare a superior PV isolation approach with isolation of all PVs for treatment of PAF. METHODS AND RESULTS: Fifty-two patients with PAF were randomized to either left superior pulmonary vein (LSPV) isolation followed by additional isolation of the right superior pulmonary vein (RSPV) in case of AF recurrence (group A, n = 27) or isolation of all four PVs followed by a repeat procedure in case of recurrence (group B, n = 25). At 1-year follow-up, 11 patients (41%) in group A and 8 patients (32%) in group B had AF relapse (P = 0.55). No significant differences in AF relapse were detected between groups at 3 and 12 months (log rank = 0.36, P = 0.54) and by Cox proportional hazards model analysis (P = 0.62). Nonsignificant PV stenosis was detected in two patients from group B. Total radiofrequency energy delivery and fluoroscopy and procedure times were lower in group A: 8.9 +/- 1.4 minutes vs 25.6 +/- 3.7 minutes (P < 0.001), 22.2 +/- 6.8 minutes vs 62 +/- 10.3 minutes (P < 0.001), and 131.8 +/- 26.5 minutes vs 222.2 +/- 32.3 minutes (P < 0.001), respectively. CONCLUSION: A staged superior PVs isolation approach confers equal success rates but with reduced radiofrequency energy delivery and fluoroscopy and procedure times compared to isolation of all PVs at the initial ablation attempt.     

Reduced Fluoroscopy During Atrial Fibrillation Ablation: Benefits of Robotic Guided Navigation

Reduced Fluoroscopy in PVI Using RN.   Background: Recently, a nonmagnetic robotic navigation system (RN, Hansen-Sensei™) has been introduced for remote catheter manipulation.
Objective: To investigate the influence of RN combined with intuitive 3-dimensional mapping on the fluoroscopy exposure to operator and patient during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial.
Methods: Sixty patients were randomly assigned to undergo PVI either using a RN guided (group 1; n = 30, 20 male, 62 ± 7.7 years) or conventional ablation approach (group 2; n = 30, 14 male, 61 ± 7.6 years). A 3-dimensional mapping system (NavX™) was used in both groups.
Results: Electrical disconnection of the ipsilateral pulmonary veins (PVs) was achieved in all patients. Use of RN significantly lowered the overall fluoroscopy time (9 ± 3.4 vs 22 ± 6.5 minutes; P < 0.001) and reduced the operator's fluoroscopy exposure (7 ± 2.1 vs 22 ± 6.5 minutes; P < 0.001). The difference in fluoroscopy duration between both groups was most pronounced during the ablation part of the procedure (3 ± 2.4 vs 17 ± 6.3 minutes; P < 0.001). The overall procedure duration tended to be prolonged using RN without reaching statistical significance (156 ± 44.4 vs 134 ± 12 minutes, P = 0.099). No difference regarding outcome was found during a midterm follow-up of 6 months (AF freedom group 1 = 73% vs 77% in group 2 [P = 0.345]).
Conclusion: The use of RN for PVI seems to be effective and significantly reduces overall fluoroscopy time and operator's fluoroscopy exposure without affecting mid-term outcome after 6-month follow-up. (J Cardiovasc Electrophysiol, Vol. 21, pp. 6–12, January 2010)     

Acute Results of Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation Using a Single Mesh Catheter

Introduction: Catheter-based pulmonary vein isolation (PVI) is an established therapy to treat patients with paroxysmal atrial fibrillation. We evaluated the efficacy of a simplified interventional procedure for PVI by using a single mesh catheter for mapping as well as ablation and with guidance of fluoroscopic imaging only.
Methods and Results: Forty-eight patients with paroxysmal atrial fibrillation were screened by cardiac computed tomography for their anatomical suitability to undergo PVI with the high-density mesh ablator catheter as the only left atrial device. The procedure was performed in 26 patients (12 males, mean age 61 years) who met the criteria of four clearly separated pulmonary veins (PVs) with an ostial diameter of 15–25 mm. No three-dimensional mapping systems or additional ablation devices were used.
In all 26 patients, all four PVs could be accessed and mapped with the high-density mesh ablator catheter . Electrical isolation was achieved in 99 of 102 (97%) of the pulmonary veins that revealed PV potentials. Mean total procedure time and fluoroscopy time were 187 ± 36 minutes and 34.6 ± 10.0 minutes, respectively.
Conclusion: The single-catheter approach using the high-density mesh ablator catheter for mapping as well as ablation reveals a high acute success rate of PVI while, at the same time, reducing the complexity of the procedure, and the procedure time. Long-term data on clinical success are needed to justify this simplified approach.     

"组合"消融术式治疗慢性心房颤动临床疗效

目的 评价"组合"消融术式治疗慢性心房颤动(房颤)的疗效及其影响因素.方法 入选2006年1月至2007年10月慢性房颤患者340例,年龄(62.2±10.1)岁,房颤病程(5.6±6.4)年.消融术式为环肺静脉隔离(CPVI)+碎裂电位(CFAEs)消融.消融术后口服华法林和胺碘酮3个月,定期随访心电图和24 h动态心电图.对首次消融术约2个月以后复发房性心律失常的患者进行二次消融.结果 337例完成消融,3例患者因并发心脏压塞终止.消融术时间(234±31)min,X线曝光时间(25±12)min.CPVI终止房颤11例(3.26%),其中直接恢复窦性心律5例,转为房性心动过速(房速)6例.326例进行CFAEs标测和消融.CFAEs消融终止房颤138例(40.9%),其中直接终止恢复窦性心律51例(15.1%),转为房速87例(25.8%).消融结束仍为房颤188例.消融术后(2.3±1.2)个月后共有房性快速心律失常(ATa)复发143例(42.4%),其中房速52例,房颤65例,房颤合并房速26例,接受再次消融121例(35.9%).3例(0.8%)心脏压塞患者中1例外科修补,2例心包穿刺引流保守治疗痊愈.股动脉假性动脉瘤3例(0.8%),经保守治疗痊愈,脑卒中2例,左下肺静脉轻度狭窄3例(0.8%).平均随访(15.4±4.3)个月,共有256例(76%)维持窦性心律[71例(31.6%)服用胺碘酮,121例(35.9%)二次消融].多变量分析显示左心房内径和合并器质性心脏病是慢性房颤消融复发的危险因素.结论 CPVI+CFAEs消融治疗慢性房颤一次消融复发率为42.4%,二次消融可以将成功率提高到76%,左心房内径和合并器质性心脏病是慢性房颤消融复发的危险因素.