Epicardial isolation of pulmonary veins with ethanol in open chest dogs

Background  Radiofrequency (RF) ablation has become a widely accepted treatment for atrial fibrillation (AF). This study aimed to identify the efficacy and safety of pulmonary vein (PV) ablation with ethanol and to explore an alternative energy source for catheter ablation of AF.

Methods  Twelve open-chest mongrel dogs were randomized into ethanol ablation group and control group. Both the injections and electrophysiological mapping procedures were performed epicardialy. In ethanol ablation group (n=6), injections were performed to circumferentially ablate the root of each PV (0.2 ml each site, 3 mm apart) with 95% ethanol using an 1 ml injector. In control group (n=6), saline was injected other than ethanol. PV isolation was confirmed with a circular catheter immediately after the procedure and at follow up of 30 days. PV isolation was defined as the absence of PV potentials at each electrode of the circular catheter positioned at the PV side of the lesions, as well as complete conduction block into left atrium (LA) during PV pacing.

Results  PV electrical isolation with complete bidirectional conduction block was achieved with ethanol immediately and at 30 days in 95% of PVs, while saline injection caused only transient conduction changes between LA and PVs. In ethanol group, histologic analysis showed transmural lesions at 30 days. And there was no evidence of PV stenosis or thrombus formation. Mean LA diameter was not significantly different between baseline and 30 days.

Conclusion  Ethanol is a safe energy source to effectively isolate PV in canine model and may be promising in endocardial ablation procedure of AF patients in the future.

     

Pulmonary vein tachycardia after pulmonary vein isolation in patients with atrial fibrillation

Background Pulmonary vein (PV) isolation has been developed to treat patients with atrial fibrillation (AF), and the electrophysiological endpoint of PV isolation is the disappearance or dissociation of pulmonary vein potentials (PVPs). Pulmonary vein tachycardia (PVT) is the dissociated PV rhythm with a rapid rate. However, the characteristics and significance of PVT after pulmonary vein isolation in patients with AF remains unclear. Methods From June 2003 to June 2005, a total of 285 consecutive patients with drug refractory AF were included in this study, and they underwent segmental pulmonary vein ablation (SPVA) or circumferential pulmonary vein ablation (CPVA). PV isolation was the initial endpoint for both approaches with documenting disappearance or dissociation of PVPs. PVT was characterized as dissociated activities within PVs with a circle length (CL) of <300 ms, and was classified into organized PVT or disorganized PVT according to the variance of CL. Systematic follow-up was conducted after initial procedures. Continuous variables were analyzed by Student’s t test and categorical variables were analyzed by chi-square test.Results Three hundred and fifteen PVs were ablated in 85 patients underwent SPVA approach, 400 circular lesions surrounding ipsilateral PVs (including 790 PVs) were produced in the rest of 200 patients received CPVA approach. Electrical isolation was achieved in all of these PVs. Of these, PVPs were abolished in 89.8% (992/1105) of the ablated PVs, dissociated PV rhythms were documented in the rest 10.2 % (113/1105) of the treated PVs. Among the 113 dissociated PV rhythms, 28 met the criteria of PVT with mean CL of (155±43) ms (2 PVTs in 2 patients received SPVA, 26 PVTs in 18 patients underwent CPVA). PVT was more frequently documented in patients underwent CPVA approach [9.0% (18/200) vs 2.3% (2/85), P=0.04]. During the 6-month follow-up, it was indicated that no significant difference existed in AF free rate between patients with PVT and those without PVT (P=0.75). Conclusions PVT dissociated from LA activations can be documented after PV isolation, especially in patients underwent CPVA approach. However, PVT does not affect the follow-up results.     

犬肺静脉心肌袖内P样细胞

目的：通过对肺静脉组织形态学的观察探讨异位兴奋和局灶性房颤起源于肺静脉的形态学基础。方法：取材于5例成年健康犬的左房和肺静脉。将组织声连续切片后行HE染色和Masson三色染色,光镜观察。结果：左房心肌延伸入肺静脉内形成心肌袖,肺静脉内心肌走行方向各异,有时呈内环外纵,有时呈纵行或斜行。肺静脉壁由三层组成,即内膜层,中间层和外膜层。P样细胞散在分布于心肌袖内,主要分布于心肌袖的中间部,并且几乎都是在上肺静脉中。肺静脉的心肌细胞与左房内的心肌细胞形态上无明显差异。结论：P样细胞可能是引发房颤的异位兴奋的形态基础。     

非接触三维标测系统指导下环肺静脉电隔治疗心房颤动的临床评价

目的:探讨非接触三维标测系统指导下环肺静脉电融隔离治疗心房颤动(房颤)的可行性和临床疗效.方法:28例药物治疗无效或不能耐受的房颤患者.其中23例阵发性房颤、5例持续性房颤.采用非接触三维标测系统(Ensite navX)建立左心房、肺静脉的三维等时电势图和电解剖图,并在距离肺静脉口1～2 cm处行环肺静脉及其周围组织电隔离.消融终点包括:完成所有环肺静脉消融径线;全部肺静脉均达电隔离;阴性诱发结果.结果:28例患者均达到消融终点;手术的总操作时间和X线曝光时间分别为(161.3±23.2)min和(38.0±6.8)min;随访6～17月,20例(71%)无房颤发作;8例(29%)有房颤复发,其中2例因其发作次数及时间均较术前明显减少未再消融,予以可达龙治疗可控制(术前可达龙治疗无效),6例行第2次消融,术中均发现肺静脉电位有不同程度的恢复,第2次术后4例房颤无再发,2例仍有发作但未再消融,予以可达龙治疗可控制.术中及随访期间无任何操作相关并发症.结论:非接触三维标测系统指导下的环肺静电隔离是治疗房颤的有效而安全的方法.肺静脉既是房颤的诱发机制,亦有可能参与房颤的维持.     

心房颤动对肺静脉肌袖结构影响的研究

目的：探讨心房颤动（atrial fibrillation,AF）时肺静脉肌袖结构的变化及其意义。方法：健康杂种犬17只,随机分为心房颤动组（11只）和对照组（6只）,应用快速心房起搏建立慢性房颤动物模型,通过HE染色、Masson 染色研究犬右上肺静脉的结构变化。结果：与对照犬相比,AF犬肺静脉肌袖内心肌细胞增大、排列紊乱;细胞核大小不甚规则,核异型性明显,细胞内可见肌纤维断裂;心肌纤维之间连接组织积聚,使心肌细胞之间的间隔增宽。从左心房到肺静脉方向,心肌袖组织逐渐变薄,末端肌束被纤维组织隔离。心肌袖内可见肌纤维方向突然改变,心肌细胞在长轴切片上显示为横断面,而在短轴切片上显示为纵切面。AF犬肺静脉肌袖内胶原组织较对照犬明显增多,排列紊乱,分布不均匀,围绕单个心肌细胞的胶原纤维网减少或断裂。结论：肺静脉肌袖结构的特殊性及其结构重构可能是形成肺静脉局部微折返的组织学基础,是AF发生和维持的重要机制。     

Impact of right upper pulmonary vein isolation on atrial vagal innervation and vulnerability to atrial fibrillation

Background Based on the hypothesis that pulmonary vein isolation could result in the damage of the epicardial fat pads, this study aimed to investigated the impact of right upper pulmonary vein (RUPV) isolation on vagal innervation to atria. Methods Bilateral cervical sympathovagal trunks were decentralized in 6 dogs. Metoprolol was given to block sympathetic effects. Multipolar catheters were placed into the right atrium (RA) and coronary sinus (CS). RUPV isolation was performed via transseptal procedure. Atrial effective refractory period (ERP), vulnerability window (VW) of atrial fibrillation (AF), and sinus rhythm cycle length (SCL) were measured at RA and distal coronary sinus (CSd) at baseline and vagal stimulation before and after RUPV isolation. Serial sections of underlying tissues before and after ablation were stained with haematoxylin and eosin.Results SCL decreased significantly during vagal stimulation before RUPV isolation (197±21 vs 13±32 beats per minute,P<0.001), but remained unchanged after RUPV isolation (162±29 vs 140±39 beats per minute, P>0.05). ERP increased significantly before RUPV isolation compared with that during vagal stimulation [(85.00±24.29) ms vs (21.67±9.83) ms at RA, P<0.001; (90.00±15.49) ms vs (33.33±25.03) ms at CSd P<0.005], but ERP at baseline hardly changed after RUPV isolation compared with that during vagal stimulation [(103.33±22.50) vs (95.00±16.43) ms at RA, P = 0.09; (98.33±24.83) vs (75.00±29.50) ms at CSd, P=0.009]. The ERP shortening during vagal stimulation after RUPV isolation decreased significantly [(63.33±22.51) ms vs (8.33±9.83) ms at RA, P<0.005; (56.67±20.66) ms vs (23.33±13.66) ms at CSd, P<0.05]. AF was rarely induced at baseline before and after RUPV isolation (VW close to 0), while VW of AF to vagal stimulation significantly decreased after RUPV isolation [(40.00±10.95) vs 0 ms at RA, P<0.001; (45.00±32.09) vs (15.00±23.45) ms at CS, P <0.05]. The architecture of individual ganglia was significantly altered after ablation.Conclusions The less ERP shortening to vagal stimulation and altered architecture of individual ganglia after right upper pulmonary vein isolation indicate that isolation may result in damage of the epicardial fat pads, thereby attenuating the vagal innervation to atria. The decreased vulnerability window of atrial fibrillation indicates that vagal denervation may contribute to its suppression.     

P波时限的缩短与成功的肺静脉隔离

目的 探讨心房颤动(简称房颤)经环肺静脉电隔离术(简称CPVA)后复发的预测因素.方法 26例接受CPVA治疗的阵发性房颤患者,测量这些患者多道电生理记录仪上电隔离术前术后体表心电图的P波时限,用超声心动图测量左房前后径、左室舒张内径,在胸部CT上测量肺静脉口最大径.结果 在术后6个月的随访中,6例在1～8周房颤复发,其余20例均维持窦律.无房颤复发组的最大P波时限由术前的(120±16)ms降至术后的(103±17)ms(P<0.000 1);而房颤复发组的最大P波时限术前术后无明显变化[(术前(124±17)ms与术后(121±19)ms,P=0.12];术前P波离散度在房颤复发组和无复发组间无明显变化[(33±12)ms与(31±16)ms,P=0.788];术后的P波离散度在两组间亦无明显变化[(34±11)ms与(22±16)ms,P=0.059].左心房内径、左室舒张内径和肺静脉最大径在房颤复发组和无复发组间也无差别.结论 P波时限的明显缩短可以作为阵发房颤环肺静脉隔离术后的复发预测指标,但仍需大样本研究证实.     

厄贝沙坦对阵发性心房颤动经肺静脉电隔离术后复发率的影响

目的探讨厄贝沙坦对阵发性心房颤动经肺静脉电隔离术后复发率的影响。方法60例接受环肺静脉消融阵发性房颤患者,平均年龄(49.3±16.1)岁。其中30例在术后常规药物治疗(抗血小板、抗凝、降压等)的基础上加用厄贝沙坦150mg/d,其余30例术后给予常规药物治疗。比较术后3个月、6个月两组患者在房颤复发率、房颤发作次数、收缩压、舒张压、左房直径方面的差异。结果术后3个月和6个月,厄贝沙坦治疗组房颤复发率显著低于常规药物治疗组(P<0.05),房颤发作次数、收缩压、舒张压、左房直径方面两组患者的差异无显著性(P>0.05)。结论厄贝沙坦可降低阵发性心房颤动经肺静脉电隔离术后的复发率。     

环肺静脉线性消融术对P波振幅及方向的影响

目的观察环肺静脉线性消融术前、术后P波的正负方向及振幅变化,探讨环肺静脉线性消融术对其的影响。方法 50例阵发性房颤患者,描记消融术前及术后7 d窦性心律下同步12导联心电图,分析各导联P波方向并测量相对应的振幅,术后定期根据症状及动态心电图随访判断手术成功与否。结果 P波正向波振幅在Ⅰ、Ⅱ、Ⅲ、aVF、V5、V6导联术后较术前明显降低(P<0.05);负向波振幅在aVR、aVF导联术后较术前明显降低(P<0.05);总振幅在Ⅰ、Ⅱ、aVR、V5、V6导联术后较术前明显降低(P<0.05)。P波极性术后Ⅲ导联负向波增多,aVL导联正向波增多。术前、术后P波正向振幅、负向振幅及总振幅在手术成功组与失败组间差异无统计学意义。结论环肺静脉线性消融术导致P波振幅明显降低,提示左心房整体除极电量下降;P波极性变化提示P波整体向量向右向下改变;P波振幅降低程度对手术成功与否无预测价值。     

可调弯鞘在心房颤动环肺静脉隔离术中的应用经验

目的 使用可调弯鞘(Agilis NxT 鞘)对阵发性心房颤动(以下简称房颤)进行导管消融隔离双侧肺静脉。方法 26例阵发性房颤患者,应用可调弯鞘支持下进双侧肺静脉行隔离术。穿刺房间隔,双侧肺静脉造影后,在EnSite Velocity^TM v3.0指导下构建左心房几何模型,行双侧肺静脉电学隔离。结果 26例患者均完成环肺静脉电学隔离。平均手术时间为(165.7±48.1)min,平均放射时间为(25.0±9.4)min,其中房间隔穿刺透视时间为(1.3±0.5)s,应用环状电极建模时间(7.5±4.3)min,左肺静脉隔离时间(55±17)min,右肺静脉隔离时间(37±11)min。有1例患者发生心脏压塞,经心包穿刺后好转。随访6~12个月,有3例患者(11.5%)复发。结论 Agilis NxT可以应用于针对阵发性房颤导管消融的环肺静脉隔离,可以减少导管在心腔内的操作,简化手术过程,具有较好的安全性和有效性。     

电视胸腔镜辅助下双侧肺静脉隔离治疗心房颤动的临床研究

目的总结11例电视胸腔镜辅助下双侧肺静脉隔离治疗心房颤动的临床经验。探讨该术式的特点及优势。方法选择2005年12月至2009年5月在同济大学附属东方医院心胸外科住院进行房颤治疗患者，房颤不能用药物控制．不能耐受抗心律失常或抗凝药物治疗的患者11例。在胸腔镜下通过小切口，使用AtriCure消融钳分别消融右侧和左侧上、下肺静脉，并切断Marshall韧带，切除左心耳。结果手术顺利，无围手术期死亡，均术后1周出院，随访未见肺静脉狭窄。9例即刻转为窦性心律，3个月随访维持窦性心律8例，总体房颤治愈率73％。结论电视胸腔镜辅助下双侧肺静脉隔离治疗房颤．有较高的安全性，同时技术简单，设备要求不高，是一项值得推广的房颤治疗手段。     

去自主神经条件下迷走神经对肺静脉不同部位房颤诱发率的影响

目的 探讨去自主神经条件下迷走神经对肺静脉不同部位房颤诱发率的影响。方法 10只健康杂种犬,经切断双侧颈迷走神经干和破坏颈交感神经节,建立动物的去自主神经模型。分别在右心耳、左心耳、左心房和四支肺静脉的近、中、远段行S1S1及S1S2程序刺激,在基础刺激及伴有双侧颈迷走神经同时刺激或阿托品作用的情况下,观察心房及肺静脉不同部位房颤诱发率的变化。结果 基础状态下,在心房及肺静脉的所有部位给予S1S2程序刺激,几乎均可诱发出房性早搏或短阵房速,而较少诱发出房颤。当同时伴有迷走神经刺激时,房颤的诱发频率明显增加;当行S1S1刺激的同时伴有双侧颈迷走神经刺激时,在心房及肺静脉的所有部位,其房颤诱发率均较基础刺激时明显升高（右心耳22．2％vs59．3％,左心耳14．8％vs55．6％,左心房18．5％vs51．9％,左上肺静脉上段33．3％vs66．7％,P〈0．05,P〈0．01）。与基础刺激比较,阿托品作用并不影响肺静脉的房颤诱发率（均P〉0．05）。结论 对于肺静脉起源的房颤,迷走神经也可能是参与其起始的重要诱发因素。     

房颤患者环肺静脉电隔离术后快速性房性心律失常的再消融治疗效果分析

目的:观察心房颤动患者环肺静脉电隔离术(CPVI)后快速性房性心律失常(ATa)的再消融治疗效果,并探讨其可能的发生机制。方法:64例阵发性房颤患者在初次行CPVI后(3.7±2.4)个月再次行电解剖标测系统指导下ATa标测和消融。结果:共标测到78种ATa,其中48种(61.5%)为局灶性机制,30种(38.5%)折返机制。在折返机制中,12例为普通房扑,18例为左房内折返,其折返环与二尖瓣峡部、左房前壁及原环肺静脉消融线上的传导间隙有关。2例患者因ATa不稳定而无法标测。64例患者中,56例(87.5%)消融即刻成功,8例需要电复律成窦性心律。术后随访13~21个月,平均(16.5±2.9)个月,60例(93.8%)患者不再发生ATa。结论:CPVI术后ATa的机制可为折返性和局灶性,可通过CARTO系统激动顺序标测成功消融治疗。     

环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动的临床研究

目的 探讨环肺静脉电隔离联合左心房线性消融治疗阵发性心房颤动(PAF,简称房颤)的临床效果与安全性.方法 选择23例PAF患者,应用Ensite3000 Navx系统和Lasso电极指导下行环肺静脉电隔离及左房顶部线、峡部线消融.消融终点为:在消融过程中房颤终止,且肺静脉电位消失,或房颤不终止,但肺静脉电位消失;若在窦律下消融,肺静脉电位消失;左心房顶部及峡部线达到完全阻滞.结果 23例PAF患者均顺利完成手术,手术时间234～297 min,平均(277±41)min,X线暴光时间29～55 min,19例患者术中出现房颤,其中14例在消融过程中房颤终止且达到肺静脉电隔离,另外5例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.左心房顶部线全部达到完全阻滞,峡部线有2例未能达到完全阻滞.随访期间发现3个月后有86.9%的患者房颤消失或明显减少.结论 环肺静脉电隔离联合左心房线性消融治疗PAF 安全、可靠. Abstract： Objective To study the clinical efficacy and safety of circumferential pulmonary vein isolation of paroxysmal atrial fibrillation(PAF) combined with left atrial linear lesion. Methods Twenty-three PAF patients were performed circumferential pulmonary vein isolation combined linear lesion of left atrial isthmus and loof with Ensite 3000 Navx and Lasso electrodes guiding. Radiofrequency end point, atrial fibrillation stopped and pulmonary vein potentials(PVPs) disappeared, or atrial fibrillation did not stop, but PVPs disappeared. PVPs disappeared if atrial fibrillation was ablated during sinus rhythm. Left atrium loof and isthmus line were complete block.Results Twenty-three PAF patients were performed ablation, operation times were from 234 to 297 minutes, X ray time was from 29 to 55 minutes, 19 atrial fibrillations occurred during operation, of which 14 atrial fibrillations stopped with pulmonary vein isolation and linear lesion, the other 5 atrial fibrillations didn't stop, but which pulmonary veins were isolated. Tour patients were performed pulmonary vein isolation during sinus rhythm. All roof lines were completely block, and 2 left atrial isthmus lines were not completely block. 86.9% patients' atrial fibrillation disappeared or decreased significantly.Conclusions It is safe and efficient to treat PAF with circumferential pulmonary vein isolation combined with left atrial linear lesion.     

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?     

肥胖患者阵发性心房颤动环肺静脉电隔离术后的预后研究

目的评价肥胖患者阵发性心房颤动(房颤)环肺静脉电隔离术后的疗效及预后。方法入选2012年1月~2014年12月在我院首次行导管消融治疗的肥胖阵发性房颤患者70例(体重指数BMI≥28 kg/m2,肥胖组),同期选择按性别、年龄、房颤病程、基础疾病、CHA2DS2-VASc评分、左心房内径、左心室射血分数匹配的70例正常BMI的阵发性房颤患者(18.5≤BMI24 kg/m~2,正常组)。两组均采用环肺静脉电隔离术式治疗。术后随访12个月,比较肥胖组与正常组的复发率,并探讨肥胖对术后复发的影响。结果术后随访12个月,肥胖组的复发率高于正常组(27.1%vs 12.9%,P0.05)。单因素和多因素分析均显示高BMI、扩大的左心房内径是阵发性房颤导管消融术后复发的独立危险因子(P均0.05)。结论肥胖患者阵发性房颤导管消融治疗是有效的。肥胖、左心房扩大是术后复发的独立危险因素。     

阵发性心房颤动的肺静脉电隔离治疗

目的 探索阵发性心房颤动的射频消融治疗方法及疗效。方法 对5例肺静脉起源的阵发性房颤患者，采用肺静脉内环状电极标测，温控导管对肺静脉电位进行射频消融，达到肺静脉完全电隔离。术后随访9～28个月，观察疗效。结果 5例患者电隔离治疗后，即刻成功率达100％；随访治愈2例，有效2例，无效1例，均无并发症发生。结论肺静脉电隔离治疗阵发性心房颤动是成功率较高，操作相对简单，比较安全的一种射频消融方法，有一定的发展前景。     

Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system

Background The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.Methods Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group Ⅰ, n=40) and by the CARTO system (group Ⅱ, n=35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins’ (PVs’) ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium （LA）. The endpoint of the procedure was complete PVs isolation. Results Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group Ⅱ were significantly shorter than in group Ⅰ ［(150±23) min and (18±17) min versus (170±34) min and (25±16) min, P=0.03 and 0.04, respectively］. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group Ⅰ and group Ⅱ ［(8±4) min and (16±11) min versus (5±4) min and (14±8) min, respectively］. The fluoroscopic durations for CPVA were (15±5) min in group Ⅰ versus (10±6) min in group Ⅱ (P=0.05), and the CPVA procedural durations were significantly shorter in group Ⅱ than in group Ⅰ ［(18±11) min versus (25±10) min, P=0.04］. AF was terminated by radio frequency delivery in 14 cases (35%) in group Ⅰ versus 5 cases (14%) in group Ⅱ (P=0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group Ⅰ versus 11 cases (31%) in group Ⅱ (P=0.004). During a mean follow-up of 7 months, 32 (80%) cases in group Ⅰ and 24 (69%) cases in group Ⅱ were arrhythmia-free (P=0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group Ⅱ. One case had moderate hemothorax in group Ⅰ. All the complications were cured by proper treatment. No PV stenosis was observed. Conclusions The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.     

灌注超声导管与冷盐水灌注射频导管电学隔离肺静脉的对比研究

目的 :对比灌注超声导管与冷盐水灌注射频导管电学隔离犬肺静脉的效果 ,以探讨灌注超声导管用于肺静脉电学隔离治疗的可行性。方法 :健康杂种家犬 2 3只 ,按不同消融方法随机分为冷盐水灌注射频导管组 (A组 ,n =12 )及灌注超声导管组 (B组 ,n =11)。房间隔穿刺后在环状电极标测指导下分别采用两种导管行肺静脉电学隔离 ,隔离 3 0min后再次评价心房与肺静脉之间 (LA -PV)电传导是否恢复。结果 :A组与B组犬肺静脉电隔离即刻成功率分别为 97. 9% (4 6/ 47)和 78 .6% (3 3 / 42 ) ,B组显著低于A组 (P <0 . 0 5 ) ;3 0min后左心房 -肺静脉电学传导恢复率分别为 71 .7% (3 3 / 46)和 2 7 .3 % (9/ 3 3 ) ,B显著低于A组 (P <0 . 0 1)。结论 :灌注超声导管电学隔离肺静脉的即刻成功率低于冷盐水灌注射频导管 ;但隔离成功后 3 0minLA -PV电传导恢复率也显著低于冷盐水灌注射频导管。     

家猪肺静脉心肌袖的形态学观测

目的　观测家猪心脏肺静脉心肌袖的大体解剖及形态特征 ,为异位房颤的临床研究与治疗提供依据。方法　解剖 30例家猪心脏 ,显示肺静脉心肌袖 ,观测其形态、厚度及长度 ,并测量肺静脉的直径及壁厚度。结果　家猪肺静脉近心房端的表面有肌袖绕行 ,其出现率为 97%。右下、右上、左上、左下肺静脉肌袖长度平均分别为 19.0 4± 4 .12 mm、16 .5 9± 3.85 mm、16 .34± 3.88m m、15 .11± 6 .11m m;肌袖厚度平均分别为 0 .81± 0 .4 8m m、1.10± 0 .5 9mm、1.10± 0 .5 9m m、0 .5 2± 0 .2 8m m;肺静脉壁厚度平均分别为 0 .17± 0 .0 5 mm、0 .2 6± 0 .17m m、0 .19± 0 .0 9mm、0 .16± 0 .0 8mm;肺静脉直径平均分别为 12 .13± 2 .4 4 mm、10 .2 4± 2 .0 7mm、11.2 3± 2 .0 9mm、6 .83± 2 .5 0 m m。结论　家猪肺静脉心肌袖出现率高 ,是制作局灶性房颤模型的理想动物。