射频导管消融电学隔离心脏大静脉治疗阵发性心房颤动的临床应用

目的评价射频导管消融电学隔离心脏大静脉预防阵发性心房颤动(房颤)发作的疗效。方法83例患者,男性58例、女性25例,年龄15～76平均(605±185)岁,有阵发性房颤病史2～15年,曾服数种抗心律失常药物疗效不佳。41例患者合并有高血压病,所有患者均无明显器质性心脏病改变。常规行心脏大静脉造影,测量靶静脉直径,将10极肺静脉环状标测导管(Lasso导管)放置在靶静脉开口内05cm处,以Lasso导管为指导,把温控大头电极导管放置于靶静脉开口处行电学隔离。结果83例患者共电学隔离大静脉343条。包括左上肺静脉(LSPV)83条,右上肺静脉(RSPV)83条,左下肺静脉(LIPV)82条,右下肺静脉(RIPV)42条,上腔静脉(SVC)53条,其中2例LSPV与LIPV共同开口。每条肺静脉行1～4段消融(平均每条消融25段),即刻电学隔离成功大静脉337条。随访2～31个月,其中50例停服抗心律失常药物后无房颤发生,13例患者房颤发作明显减少,20例患者房颤发作消融前后无明显变化。并发症有2例术中出现左侧大量胸腔积血,1例心肺复苏5天后出现脑死亡。发现肺静脉狭窄21例,其中轻度狭窄15例,重度狭窄6例,无肺静脉闭塞。结论(1)成功的心脏大静脉电学隔离治疗阵发性房颤的总有效率达到75%左右;(2)由于很难确定靶肺静脉,成功电学隔离各心脏大静脉有可能提高治愈率;(3)此     

对心房颤动射频导管消融治疗的再认识

自1998年起,心房颤动(房颤)的导管消融治疗就成为临床心电生理学研究的持续热点,目前在国外部分医疗中心,单中心房颤导管消融的治疗例数已逾千例。近2年多来,随着治疗主要技术的日臻完善,不仅其成功率再创新高,适应证扩展至几乎整个房颤临床谱,而且临床研究的结果还对房颤机制的研究产生了重要影响(即所谓“learningbyburning”)。因此可以说,晚近有关房颤导管消融的临床实践已经从一定程度上更新了对这项治疗本身乃至房颤机制的若干认识,并很可能成为未来房颤治疗的主要方法。肺静脉电隔离术　　肺静脉电隔离术是现阶段房颤导管消融治疗的…     

阵发性心房颤动的射频导管消融大静脉电隔离治疗

目的报道阵发性心房颤动(房颤)的射频导管消融电隔离肺静脉和腔静脉的疗效。方法阵发性房颤患者36例,年龄(42.5±13.2)岁。经1次房间隔穿刺放置环状标测电极导管(Lasso导管)和冷盐水灌注消融导管,在Lasso导管的指导下,采用全肺静脉或上腔静脉与靶静脉节段性电隔离相结合的方法对肺静脉和腔静脉行标测和电隔离治疗。窦性心律时最早激动的肺静脉和腔静脉电位处和/或心房起搏时最短的心房和静脉电位间期处为靶点行消融。结果36例阵发性房颤患者均接受一次电隔离治疗,共电隔离大静脉115根,其中左上肺静脉34根,左下肺静脉22根,右上肺静脉30根,右下肺静脉17根,上腔静脉12根,即刻电隔离成功率为95.6%,术中并发症发生率2.78%。随访3~22个月,成功率(无房颤发作或房颤发作明显减少)为75.0%。结论射频导管消融电隔离肺静脉或腔静脉与心房间的电活动连接,可有效预防房颤的复发。治疗的关键是消融靶点的标测和确定。     

射频导管消融进行心房-肺和/或上腔静脉电隔离治疗阵发性心房颤动

目的　总结射频导管消融行心房 肺和 /或上腔静脉 (大静脉 )电隔离治疗阵发性心房颤动 (房颤 )的疗效。方法　选择发作频繁、症状明显 ,药物治疗无效的 10 0例阵发性房颤患者 ,男性 72例、女性 2 8例 ,年龄 2 7～ 75(54± 10 )岁 ,均无瓣膜病等器质性心脏病依据。在环状标测电极导管 (Lasso导管 )指导下行心内电生理标测和心房 靶大静脉 (指术中标测证实为房颤相关的肺静脉或上腔静脉 )电隔离和 /或经验性大静脉电隔离 (指术中无心律失常发作而不能明确房颤相关大静脉 ,主要对双上肺静脉和左下肺静脉进行电隔离 )。结果　 10 0例患者共接受电隔离治疗 12 0次。行单纯心房 靶大静脉电隔离 2 2例 ,经验性大静脉电隔离 78例 ,共电隔离大静脉 2 68根 ,其中肺静脉 2 44根 ,上腔静脉 2 4根。即刻电隔离成功 2 57根 (96% )。平均随访 (2 2 9± 177)d ,随访期内停用所有抗心律失常药物 (部分患者服小剂量β受体阻滞剂 ) ,无房颤发作 65例 (65% ) ,房颤发作明显减少 12例 (2例服用胺碘酮后 ,12 % ) ,总有效率 77%。并发症包括脑卒中 2例 ;肺静脉狭窄 9例 ,其中单支轻度狭窄 7例 ,2支重度狭窄 1例(均为 2次消融 ) ,左上肺静脉完全闭塞 1例 ;术后心包积液 2例。并发症的总发生率为 13 %。结论　(1)使用Lasso导管     

经导管射频消融治疗起源于肺静脉的心房颤动（？…

报道２例经射频消融治疗成功的起源点位于肺静脉的心房颤动（简称房颤）均伴有频发房性早搏（简称房早）的阵发性房颤,电生理检查时行两次房间隔穿刺,将两根１０极标测导管通过长鞘送入左,右上肺静脉,选择性肺静脉造影证实肺静脉开口部位,静脉滴注异丙肾上腺素后１例诱发出频发房早,另１例诱发出频发房早及房颤,且房早及房颤开始发作时的心内电图无间显示最早心房激动点位于右上肺静脉内,其局部电位分别产体表心电图异位Ｐ波     

阵发性心房颤动射频导管消融进行心房-肺静脉电隔离术的方法学

~~阵发性心房颤动射频导管消融进行心房肺静脉电隔离术的方法学@杨延宗!116001$大连医科大学附属第一医院心内科 @刘少稳!116001$大连医科大学附属第一医院心内科 @高连君!116001$大连医科大学附属第一医院心内科 @林治湖!116001$大连医科大学附属第一医院心内科~~     

导管消融治疗心房颤动的个体化策略

心房颤动（房颤）的导管射频消融历经10年多的努力，终于在近两年有了突破性的进展。这主要表现在以下几个方面：第一，消融病例数逐年大幅度增多。全球各大电生理中心每年完成的例数在数百乃至上千；国内每年完成的病例数也呈几何级数增长。第二，适应证进一步拓宽。房颤的病例选择覆盖了早年的非器质性心脏病的局灶性房颤及随后的阵发性和持续性房颤乃至目前的器质性心脏病合并心功能不全的永久性房颤。     

射频导管消融进行心房-肺(或上腔)静脉电隔离治疗阵发性心房颤动的并发症分析

目的总结射频导管消融进行心房 肺静脉和 /或上腔静脉 (合称大静脉 )电隔离治疗阵发性心房颤动 (房颤 )的并发症。方法顽固性阵发性房颤患者 89例 ,在环状标测电极导管指导下行大静脉的射频导管消融电隔离治疗 ,分析出现的各种并发症。结果 89例病人共接受电隔离治疗 10 3次 ,隔离大静脉 2 30根 ,其中肺静脉 2 0 7根 ,上腔静脉 2 3根。出现并发症 10例 ,其中严重迷走神经反射导致的一过性三度房室阻滞引起的晕厥发作 2例 ,脑卒中 2例 ,肺静脉狭窄 4例 (狭窄程度 >5 0 % ) ,术后少量心包积血 2例 ,并发症的总发生率为 11%。结论射频导管消融进行心房 肺和 /或上腔静脉电隔离治疗阵发性房颤可出现各种并发症 ,多数并发症可通过采取相应的措施使之减少或避免 ,其中肺静脉狭窄和脑卒中为最棘手的并发症 ,应予以高度重视。     

经心外膜导管射频消融治疗犬心房颤动的实验研究

目的 探讨射频消融心房颤动(房颤)的可行性和最佳消融径线。方法用乙酰甲胆碱 短阵快速电刺激诱发犬持续性房颤横型，直枧下用直径4mm的大头消融电极逐点消融，形成线性消融，左房消融径线3条，右房消融径线2条．Baehmon束1条。结果 5只犬在窦性心律下消融左房心外膜3条径线，消融后均可再诱发房颤，再消融右房1条径线，仍有4只犬能诱发出持续性房颤．再加上右心房、右心耳连接部和Bachmon束两条径线消融．仅有1只犬能诱发出房颤，后8只犬选择消融右房、右心耳连接部后，4只犬仍能诱发房颤。再加消融Bachmon束后，均不能诱发房颤。消融后左、右房．左上、下肺静脉口的有效不应期均较消融前延长(P<0．05或<0．01)。结论对于此种房颤模型，仅消融右房的关健部位可部分有效,进一步消融Bathmom束后可提高成功率。射频消融房颤的主要作用为延长心房有效不应期。     

普通射频消融导管电隔离肺静脉治疗局灶性心房颤动

导管射频消融治疗起源于肺静脉的局灶性心房颤动(房颤 ) ,是近年来心律失常介入治疗领域的热点 ,我们应用普通射频消融导管 ,通过消融肺静脉口 ,对 6例局灶性房颤患者成功地实施了肺静脉与左心房之间的电隔离。一、资料与方法6例患者均为男性 ,年龄 4 1～ 6 3岁 ,有阵发性房颤病史3～ 10年 ,心电图示频发“ＰｏｎＴ”房性早搏 (房早 ) ,房早诱发短阵房颤 ,持续数分钟和数小时不等。房颤发作频繁 ,3～ 4种抗心律失常药物治疗无效 ,行心内电生理检查及导管射频消融术。主肺动脉造影显示肺静脉解剖位置后 ,两次房间隔穿刺放置 7Ｆ 10极Ｌａｓｓ…     

Cost analysis of radiofrequency catheter ablation for atrial fibrillation

Atrial fibrillation is the most common arrhythmia associated with increased mortality and morbidity. Its management requires high healthcare expenditures; 52%–70% of expenses for AF care are constituted by hospitalization costs. The current management strategies of pharmacological rhythm control and pharmacological or invasive rate control show no difference in impact on major outcomes in patients with AF. Radiofrequency catheter ablation (RFA) has been shown to reduce the risk of AF recurrence, improve quality of life and reduce hospitalization rate as compared to pharmacological rhythm control and rate control strategies. This review summarizes current knowledge on cost and cost-effectiveness analysis of RFA for patients with atrial fibrillation.     

Curative catheter ablation for atrial fibrillation

Optional statement With the recent advances in the understanding of the mechanisms of atrial fibrillation, radiofrequency catheter ablation has emerged as an effective therapeutic modality for patients with atrial fibrillation. Techniques for catheter ablation evolved from elimination of triggers that often originate within the pulmonary veins and initiate atrial fibrillation, to additional left atrial ablation using a variety of approaches to also eliminate the mechanisms that play a role in perpetuation of atrial fibrillation. With the current ablation strategies, atrial fibrillation can be eliminated in approximately 85% of patients with paroxysmal, and in approximately 70% of patients with chronic, atrial fibrillation with a low incidence of significant complications. In symptomatic patients with paroxysmal or chronic atrial fibrillation who have failed antiarrhythmic drug therapy, catheter ablation is an effective treatment strategy for maintenance of sinus rhythm.     

关于心房颤动转子机制与消融的几点思考

历经十几年的不懈研究,心房颤动（房颤）的发生机制已经逐渐清晰,主要是由位于肺静脉等部位的异位兴奋灶触发引起。然而,房颤的维持机制却始终未明,而且充满争论。晚近, Narayan 等[2]报道的 CONFIRM 研究显示：以往只是在房颤模型上记录到的转子（ rotor）在临床房颤患者中确实存在。而且,通过针对性地消融这些转子或者异位兴奋灶,不仅能在术中即刻终止房颤,还带来远胜传统消融术式的单次消融随访成功率（82．4%对44．9%）。     

阵发性心房颤动的电生理机制及导管射频消融的初步研究

目的　探讨阵发性心房颤动 (房颤 )的电生理机制和右房峡部消融对房颤的影响。方法　1 995年 6月～ 1 999年 6月 ,1 5例药物治疗无效的阵发性房颤 ,男性 8例 ,女性 7例 ,年龄 (5 6± 9)岁 ,病程 (7± 4)年 ,消融前 3个月平均每月发作 6次至每日数十次不等 ,发作时均有明显症状 ;对照组 1 5例房室结折返性室上性心动过速 ,男性 5例 ,女性 1 0例 ,年龄 (5 7± 6 )岁。电生理检查及消融 ,房颤组和对照组均测量房室结正向和逆向传导文氏点 (Wenckebach point)。程序电刺激诱发房颤 ;在右房峡部线性消融。结果　房颤组房室结正、逆向文氏点分别为 (34 0± 38) m s和 (6 1 8± 75 ) ms,两者差异具有显著性 (P<0 .0 0 1 ) ;对照组正、逆向文氏点分别为 (34 5± 5 2 ) ms和 (338± 48) m s,两者之间差异无显著性 (P>0 .0 5 ) ;两组间正、逆向文氏点离散度差异 (正、逆向文氏点之差 )具有显著性 (P<0 .0 0 1 )。房颤组可用短阵快速刺激 (burst)诱发房颤 ,9例房颤由心房扑动 (房扑 )蜕变而成 ,7例消融后即刻成功 ,随防 3个月～4年 ,3例无房颤复发 ,1例随访时间最长达 3年 6个月 ;其余病例房颤发作频度较术前减少 70 %～95 %。结论　部分阵发性房颤患者在右房内与房扑一样存在大折返环 ,这些患者房颤由房扑蜕变而来     

Left atrial volume and dominant frequency of atrial fibrillation in patients undergoing catheter ablation of persistent atrial fibrillation

Background  

Prior studies have suggested that left atrial (LA) volume and frequency of atrial fibrillation (AF) are associated with suboptimal outcomes in patients undergoing catheter ablation of AF. However, the interaction of these factors and their relative impact on outcome are not clear.     

Cost-effectiveness of catheter ablation for atrial fibrillation

PURPOSE OF REVIEW: Catheter ablation for atrial fibrillation is a rapidly evolving field. It has been adopted at many institutions worldwide. This review compares the efficacy and cost of catheter ablation and medical therapy in atrial fibrillation patients. RECENT FINDINGS: There is emerging evidence for clinical superiority of catheter ablation over medical therapy for restoring and maintaining sinus rhythm in atrial fibrillation patients. Early analyses of costs related to catheter ablation in atrial fibrillation suggest that medical therapy and catheter ablation become cost-equivalent at about 5 years of follow-up. A recent cost-effectiveness study concluded that catheter ablation is a cost-effective alternative to medical care in younger and older patients at low and moderate risk of stroke, assuming that restoration and maintenance of sinus rhythm with ablation would have some protective effect with respect to embolic events. SUMMARY: Catheter ablation is a potentially cost-effective strategy in select patients with atrial fibrillation. Long-term randomized studies that compare it to conventional care and focus on outcomes of morbidity and mortality are necessary prior to widespread application of this technique.     

心房颤动射频消融中SmartTouch压力导管的应用

目的为进一步提高心房颤动(简称房颤)导管消融手术成功率并降低并发症,分别对比使用SmartTouch压力感应导管与普通冷盐水灌注NaviStar导管进行房颤导管消融。方法共纳入100例房颤患者,分为对照组(NaviStar,n=50)和研究组(SmartTouch,n=50),两组均在Carto三维标测系统下进行双侧肺静脉隔离。采集两组患者的一般资料、手术时间、X光曝光时间,观察术后窦性心律维持率,比较两组之间的差异。结果两组患者总手术时间、左房建模时间、并发症发生无统计学差异。研究组X线曝光时间较短[(25.4±5.3)min vs(38.7±7.5)min]、肺静脉隔离时间较短[(59±13)min vs(72±16)min],术后3个月(47/50vs 44/50)、术后半年(46/50vs37/50)、术后1年(46/50vs 32/50)窦性心律维持率均优于对照组(P均0.05)。结论 SmartTouch压力导管能提高手术成功率。     

Complications of catheter ablation for atrial fibrillation

Catheter ablation of atrial fibrillation is a modern therapeutic method that effectively prevents arrhythmia recurrences. Because of the complexity nature of this procedure, it is not surprising that the rate of complications is higher compared with other types of catheter ablations. This review focuses on the most important complications, and discusses their prevention, diagnosis and therapy.     

Frontier of catheter ablation for atrial fibrillation

The sudden evolution of catheter ablation (CA) therapy for atrial fibrillation (AF) was brought by the discovery of a new insight into the triggering mechanism of AF by Haïssaguerre et al. in 1998. This discovery opened a new era of evolution of ablation therapy of paroxysmal AF (PAF). At the frontier of AF ablation, technical development of CA for long-standing persistent AF (CAF) has been done enthusiastically, although the detailed electrophysiologic mechanism and anatomical substrate of persistent AF remain unknown. Stepwise ablation composed of multiple procedures, circumferential pulmonary vein isolation (PVI), biatrial defragmentation, and anatomical linear ablation with the endpoint of AF termination has been the most widely accepted method, because the efficacy of this method was reported to be surprisingly high during a relatively short duration of follow-up. Recently, they showed this strategy has a significant limitation in efficacy for CAF with long AF duration (>7 years), enlarged left atrium (>50 mm in left anterior descending artery), short AF cycle length (AFCL) (<130 ms) and impaired cardiac function. For cases associated with these clinical, anatomical, and electrophysiological parameters, AF termination as an endpoint might be abandoned if peak prolongation of AFCL, reduction of intra-/inter-atrial AFCL gradient, and low defibrillation threshold are attained after predetermined lesion set is completed. Prolonged procedure with massive tissue ablation to attain AF termination should be avoided, because it potentially increases adverse events during and immediately after the procedure and causes extensive scar-formation in both atria with atrial mechanical dysfunction.