经导管射频消融治疗起源于肺静脉的心房颤动(附二例报告)

报道 2例经射频消融治疗成功的起源点位于肺静脉的心房颤动 (简称房颤 ) ,均伴有频发房性早搏 (简称房早 )的阵发性房颤。电生理检查时行两次房间隔穿刺 ,将两根 10极标测导管通过长鞘送入左、右上肺静脉 ,选择性肺静脉造影证实肺静脉开口部位。静脉滴注异丙肾上腺素后 1例诱发出频发房早 ,另 1例诱发出频发房早及房颤 ,且房早及房颤开始发作时的心内电图均显示最早心房激动点位于右上肺静脉内 ,其局部电位分别较体表心电图异位 P波的起点提前 61和 96ms。在最早心房激动点处以 15～ 2 0 W的输出功率消融 60～ 180 s后房早及房颤消失 ,静脉滴注异丙肾上腺素亦未再诱发房颤。术后随访 8～ 12个月 ,房颤无复发。结论 :射频消融治疗起源于肺静脉的房颤效果较好且相对安全 ;在这类患者应用两根多极导管同步标测双上肺静脉是一种有效的标测和消融方法。

Radiofrequency Catheter Ablation of Atrial Fibrillation Originating From the Pulmonary Veins:Two Cases Report

We described our initial experience in radiofrequency catheter ablation of two cases of paroxysmal atrial fibrillation (AF) originating from the pulmonary veins (PV) which was associated with frequent isolated atrial ectopic beats.After atrial transseptal procedure,two decapolar mapping catheters were put into the right superior PV (RSPV) and the left superior PV (LSPV) through two long sheeths,which were confirmed by selective pulmonary venography.Spontaneous atrial ectopic beats was observed in one patient under isoproterenol infusion.The same protocol induced frequent atrial ectopic beats and AF in another patient.Earliest atrial activation during atrial premature beats and at the onest of AF was recorded inside the RSPV,characterized by a local depolarization preceding the atrial ectopic beats on the surface electrocardiogram by 61 and 96 msec respectively.Radiofrequency energy (15 to 20 W) was delivered to the site with earliest recorded ectopic activity for 60 to 180 seconds.After ablation,atrial premature beats and AF were eliminated without recurrence under isoproterenol infusion.During a follow up period of 8 to 12 months,no recurrence of AF occurred.It is suggested that radiofrequency catheter ablation seems to be a relatively safe and highly effective modality for treatment AF originating from the PVs,and the technique using double multielectrode mapping catheters is helpful in mapping and ablation of this kind of AF.