阵发性心房颤动的环肺静脉电隔离单环消融及双环消融术的比较

目的 比较环肺静脉电隔离单环消融和双环消融治疗阵发性心房颤动(简称房颤)的疗效.方法 将40例抗心律失常药治疗无效或出现严重不良反应的阵发性房颤患者,按随机数字表法分为单环消融组和双环消融组,每组20例.单环消融组距肺静脉口0.5 cm作肺静脉单环电隔离线；双环消融组距肺静脉口0.5 cm和1 cm处,分别作肺静脉单环电隔离线.对2组患者手术时间、X线曝光时间,术后6、12个月治愈情况及肺静脉狭窄并发症的发生进行比较.结果 术前2组年龄,房颤发病时间、发作频率,左房内径等比较差异均无统计学意义(均P＞0.05).2组手术时间、术中X线曝光时间比较差异均无统计学意义(均P＞0.05).术后6个月,双环消融组的一次手术治愈率为90％,高于单环消融组的80％(P＜0.05)；术后12个月,双环消融组二次手术治愈率为95％,明显高于单环消融组的二次手术治愈率的90％ (P＜0.05).术后6个月2组均未发生肺静脉狭窄.结论 环肺静脉电隔离双环消融治疗阵发性房颤较单环消融效果好.

Comparison between Monocyclic Ablation and Bicyclic Ablation in Circumferential Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Objective To compare the effects of circumferential pulmonary vein（PV）isolation with monocyclic ablation（MA） and bicyclic ablation（BA） on paroxysmal atrial fibrillation（PAF）.Methods Forty PAF patients with resistance to anti-arrhythmic drugs or serious adverse reactions were randomly divided into two groups,with 20 patients in each group.In MA group,monocyclic electricity isolation line was made 0.5 cm from the PV ostium.In BA group,monocyclic electricity isolation line was made 0.5 and 1 cm from the PV ostium,respectively.Operative time and X-ray exposure time were determined and cure rate and incidence of pulmonary vein stenosis were recorded 6,12 months after operation.Results There were no significant differences in age,onset time,attack frequency,left atrial diameter and underlying heart disease between the two groups（P0.05）.There were no significant differ-ences in operation time,intraoperative X-ray exposure time between the two groups（P0.05）.The cure rate in BA group was significantly higher than that in MA group 6 months after the first operation（90% vs 80%,P0.05）,as well as 12 months after the second operation（95% vs 90%,P0.05）.No pulm-onary vein stenosis was found 6 months after operation in both groups.Conclusion In contrast to MA,circumferential PV isolation with BA is better effective for PAF.