心房颤动导管射频消融对心脏起搏器安全性影响的临床研究

目的评价植入起搏器患者经导管射频消融治疗慢性心房颤动(房颤)的安全性。方法18例永久性心脏起搏并房颤患者,其中男性12例,女性6例,年龄55～78岁,平均年龄68.67岁(标准差8.72岁)。分析其接受导管射频消融术中全程记录的心电信息,判断有无感知、起搏功能不良及房室失夺获、噪声反转等现象,并用起搏器程控仪于导管射频消融术前及术后第1天观察房室感知、起搏阈值及电极阻抗等参数的变化。结果18例患者均顺利完成导管射频消融,肺静脉前庭电学隔离率为100%。导管射频消融前后起搏器感知、起搏阈值及阻抗的变化无统计学意义(P>0.05)。导管射频消融过程中,3例(17%)出现噪声反转,3例(17%)出现感知不良,1例(6%)出现起搏功能不良致心室失夺获,均于停止放电后恢复正常。3例(17%)慢性持续性房颤患者在电复律后出现一过性感知不良。结论射频电流和电复律可引起一过性感知、起搏功能的障碍,但一般不引起起搏、感知阈值及电极阻抗的改变。对于已植入心脏起搏器的慢性房颤患者,在需行导管射频消融术时是安全的。

Impact of radiofrequency catheter ablation for atrial fibrillation in patients with pacemakers

Objective To investigate the impact of radiofrequency catheter ablation for atrial fibrillation(AF)in patients with pacemaker.Methods The frequency of sensing and pacing dysfunction,failure to capture and noise mode switching phenomena were determined by analyzing endocardiac electrocardiogram records during catheter ablation procedure for AF in 18 patients with pacemaker.The changes in sensing and pacing threshold,lead impedance by interrogating before and one day after AF ablation were evaluated.Results All patients received catheter ablation for AF successfully and 100 % pulmonary vein atriums were isolated.Changes in the sensing and pacing thresholds,impedance of atrial and ventricular leads after AF ablation were not found.Transient abnormal pulse generator behaviors eg.noise mode switching(n = 3),sensing dysfunction(n = 3),and pacing dysfunction cause to fail to capture ventricle(n = 1),were seen during ablation procedure but without permanent malfunction.Transient sensing dysfunction was recorded in 3 patients with persistent AF after electric cardioversion.Conclusion Radiofrequency current and electric cardioversion could result in transient sensing and pacing dysfunction,but do not cause the changes in sensing threshold,pacing threshold and impedance of lead.Thus catheter ablation for AF is safe in patients with pacemaker.