射频消融房室交界区和植入起搏器治疗心房颤动

目的 对9例阵发性心房颤动(房颤)和8例慢性房颤患者行房室交界区消融和植入起搏器(Abl+Pm)治疗,探讨这一方法的临床治疗效果。方法 经右股静脉植入4极电极导管于右心室心尖部和4极大头消融导管至房室交界区,于记录到希氏束电位处放电消融,直至出现三度房室阻滞,然后植入VVI或DDD起搏器。结果 所有患者均成功阻断房室交界区并植入起搏器。8例慢性房颤患者植入VVI起搏器,术后血流动力学稳定、临床症状改善,3个月后心胸比例由原来的0.62±0.04缩小为0.57±0.05,差异有显著性(P<0.05),心功能(NYHA分级)均提高Ⅰ级以上;9例阵发性房颤患者中,8例植入VVI起搏器,1例植入DDD起搏器,房颤发作时,8例无临床症状,1例仅有轻微心悸。随访1～47个月,无1例出现起搏器综合征、栓塞和心功能恶化。结论 房颤患者的Abl+Pm治疗可有效控制临床症状、改善心功能和提高生活质量。

Atrioventricular junction ablation combined with cardiac pacemaker implantation for refractory atrial fibrillation

Objective To evaluate the combined treatment of atrioventricular junction ablation and cardiac pacemaker implantation for refractory atial fibrillation (AF) . Methods Nine patients with paroxysmal AF and eight patients with chronic AF were included in this study. During the ablation procedure, a 6F quadripolar electrode catheter and a 7F ablation catheter were positioned at the right ventricular apex and His bundle area through the right femoral vein respectively. Radiofrequency current was delivered at the atrioventricular junction while His bundle po-tential was recorded, and complete avtrioventricular block was induced. After that, a VVI or DDD pacemaker was implanted in every patient. Results During the follow-up of 1 - 47 months, the clinical symptom, quality of life and cardiac functions were significantly improved in all 8 patients with chronic AF. Except of one patient stili felt a slight palpitation, the other 8 patients did not have any symptom when the paroxysmal AF occurred. No pacemaker syndrome and embolism happened during follow-up. Conclusion Atrioventricular junction ablation combined with cardiac pacemaker implantation can effectively improve the clinical symptoms, cardiac functions and quality of life in patients with either paroxysmal or chronic AF with congestive heart failure or hemodynamic compromise.