双Lasso导管和三维标测指导下环肺静脉线性隔离术治疗心房颤动

目的在双Lasso导管和三维标测指导下环肺静脉线性消融并彻底隔离肺静脉以治疗心房颤动(简称房颤)。方法28例房颤患者接受射频消融治疗,其中阵发性房颤12例,持续性房颤16例。所有患者首先利用三维电解剖标测系统(CARTO)进行左房重建,然后将两根Lasso导管同时置入右(左)上下肺静脉内,在肺静脉口外0.5~1cm左右行环肺静脉线性消融,消融终点为左房-肺静脉完全性传导阻滞。结果28例均电隔离成功,肺静脉完成隔离后,共86.6%(97/112)的肺静脉内可见缓慢自律性电活动。手术时间205±67min,X线透视时间27±16min,无并发症发生。术后随访8.5±3.7个月,23例无房颤复发,总成功率82.1%。结论双Lasso导管和三维标测指导下有明确电学隔离指标的环肺静脉线性消融术治疗房颤安全而有效。

Linear ablation and circumferential isolation of the pulmonary vein guided by 3D mapping and the double-Lasso technique in patients with atrial fibrillation

Objective To perform complete pulmonary vein (PV) isolation with circular lesions around the PVs guided by 3D mapping system and the double-Lasso catheters in patients with atrial fibrillation(AF). Methods 28 patients were referred for radiofrequency catheter ablation. Among them, 12 patients had paroxysmal AF and 16 Patients had persistent AF.After reconstruction of the left atrium by using Carto system,two Lasso catheters were located in the two ipsilateral PVs simultaneously. Then, circumferential ablation was performed at a distance of 0.5~1 cm away from the ostium of PVs.The endpoint was complete conduction block between left atrium and PVs. Results Successful isolation of PVs was achieved in all patients. After isolation, slow automatic activity was observed in 86.6%(97/112) PVs.The procedure time was 205±67 min and the X-ray exposure time was 27±16 min.No complication occurred during the procedure. During a mean follow-up of 8.5±3.7 months, 23 patients were free of AF recurrence with a total procedure success rate of 82.1%. Conclusions The present approach provids clear evidence that PV isolation through circular lesions around the PVs guided by 3D mapping system and double-Lasso catheters is effective and safe for treating AF.