阵发性心房颤动患者肺静脉与心房电连接特征的临床研究

目的 总结阵发性心房颤动(房颤)患者肺静脉的电生理标测和导管射频消融电隔离的结果，评估中国人肺静脉与心房的电连接类型和特点。方法 顽固性阵发性房颤患者43例，在环状标测电极指导下行肺静脉电位(PVP)记录和分析，并对能标测到PVP的肺静脉进行开口部的点或段的消融电隔离治疗。根据窦性心律和心房起搏下的肺静脉内环形标测电报导管标测到的PVP的激动顺序，以及有效放电对PVP的影响，分析和总结肺静脉与心房之间的电连接特点。结果 共标调和域电隔离肺静脉100根，其中呈单束状电连接35根(35％)，双束状电连接48根(48％)，多束状电连接11根(11％)，环状电连接3根，无电连接3根。结论 根据环状电报标测到的PVP激动顺序和对放电的反应，提示肺静脉与心房之间电连接的类型多为单束状和双束状(83％)，说明对于大多数肺静脉不必进行环状消融，而只需在肺静脉与心房连接处进行点状或节段性消融即可达到完全电隔离的效果。

Characteristics of electrical connections between atria and pulmonary veins in patients with paroxysmal atrial fibrillation

Objective The characteristics of ele ctrical connections between at ria and pulmonary veins(PVs) were evaluated by summarizing the mapping and ost ial ablation data of PVs in patients with paroxysmal atrial f ibrillation (PAF). Methods Forty-three patients referre d for electrical isolat ion of PVs by radiofrequency ablation to control drug-resistant PAF were enroll ed. Guided by circular mapping catheter, the activation sequence of PV potential (PVP) during sinus rhythm and atrial pacing, and its response to effective ra diofrequency current delivery were analyzed. Results One h undred PVs were mapped and abl ated. It was found electrophysiologically that, one bundle connection pattern in 35 veins (35%), two bundle connection pattern in 48 (48%), multiple bundle connection pattern in 11 (11%), circumferential connection pattern in 3 and no connection in 3. Conclusion From the data of ostial circular mapping and radiof requency ablation of PVs, it is concluded that 83% of PVs can be defined as one bundle and two bundle connection pattern electrophysiologically, which implies that the circumferential ablation is not necessary to electrophysiological isola tion of the PVs from the left atria in most patients with PAF.