冷盐水导管射频消融肺静脉电隔离术治疗阵发性心房颤动的疗效观察

目的：探讨冷盐水导管射频消融肺静脉电隔离术治疗阵发性心房颤动的初步疗效。方法：选择6例阵发性房颤行肺静脉及大静脉电隔离术。常规穿刺成功后做电生理检查同时行房间隔穿刺，用环状电极标测肺静脉的肌袖电位，并确定与心房之间的传导关系。用冷盐水灌注导管消融肺静脉及腔静脉，并于术后服用胺碘酮或普鲁帕酮，连续服用3个月，临床症状减轻且无房颤发生则可停药。结果：6例房颤患者中共隔离肺加上腔静脉22条，左上肺静脉8条，左下肺静脉6条，右上肺静脉4条，右下肺静脉2条，上腔静脉2条，平均每人3．7条。平均随访8个月。术后3个月1例无任何心律失常，2例有间断发作，2例有房性早搏无房颤发生（Hoher证实），1例术前持续性房颤术后为间歇发作．3个月后偶发。所有患者术后临床症状都明显减轻甚至无症状。1例发生术中心包填塞，无1例行2次手术。结论：阵发性房颤采用冷盐水导管射频消融电隔离肺静脉对绝大多数患者是有效的，对另一少部分可以减少发作。

Therapeutic Effects of Radiofrequency ablated Pulmonary Vein Electrical Isolation with Cold Brine Tube for Paroxysmal Atrial Fibrillation

Objective: To investigate the initial effects of radiofrequency ablated pulmonary vein electrical isolation therapy with cold brine tube for the treatment of paroxysmal atrial fibrillation.Methods: Six patients with paroxysmal atrial fibrillation,who had been treated with pulmonary vein and large vein electrical isolation were enrolled.After the success of common puncture,electrophysiologic study and atrial septum puncture,were done.Circular electrode mapped myocardium sleeve potential of pulmony vein,and ascertained the conduction relationship with atrium.Ablated pulmonary vein and vena cava with cold brine,and took amiodarone or propafenone for three months after the operation.If clinical symptoms alleviated and atrial fibrillation disappeared,medicine was stopped.Results:Among the six patients,there were 22 twigs pulmonary vein or superior vena cava isolated,of which,left superior pulmonary vein were 8,left inferior pulmonary vein were 6,right superior pulmonary vein were 4,right inferior pulmonary vein were 2,and superior vena cava were 2.Each had 3.7 twigs in average.During 8 months of follow-up,one case didn't occur any cardiac arrhythmia,two cases occurred to be intival,two cases suffered atrial premature beat but without atrial fibrillation.Persistent atrial fibrillation changed into discontinuous paroxysmal in one case after the operation,and changed into intival episode after three months.Clinical symptoms in all the patients were significantly alleviated or disappeared completely.One case had pericarolial tamponade.Conclutions: To most patients,it is effective to treat paroxysmal atrial fibrillation by radiofrequency ablated pulmonary vein electrical isolation therapy with cold brine tube,and may prevent the reocurrence.