在心房颤动持续过程中行肺静脉电学隔离术的可行性

探讨在心房颤动 (简称房颤 )持续过程中行肺静脉电学隔离术的可行性。 9例在导管消融术中房颤持续发作的房颤患者 ,根据肺静脉环状标测电极导管记录的肺静脉激动特征采用 2种方法进行肺静脉开口部的消融 :①肺静脉激动有序且有一种或多种固定的激动顺序 ,采用射频导管消融环状电极记录的最早的激动部位 ;②肺静脉激动无序或无明确的激动顺序 ,首先使用超声球囊导管消融 ,如未达终点再加用射频导管消融。 2种方法的消融终点均为肺静脉电学隔离。总计对 31根肺静脉进行了消融 ,其中 2 8根在房颤心律下消融。房颤心律下电隔离肺静脉的成功率为 92 .9% (2 6根 )。总操作时间和X线透视时间分别为 1 38± 2 1min和 38± 9min。本组无肺静脉狭窄及其他并发症。随访 6 .3± 2 .9(3～ 1 1 )个月后 ,4例 (44.4% )患者无房颤发作 (无需药物 )。结论 :在房颤持续过程中行肺静脉电学隔离术方法可行 ,且较为安全 ;联用超声球囊消融和射频消融对于房颤发作过程中无序或无明确激动顺序的肺静脉具有较好的电学隔离效果。

The Feasibility of Veins Lsolation During Sus-tained Atrial Fibrilllation

The purpose of this study was to determine the feasibility of pulmonary veins (PVs) isolation during ongoing atrial fibrillation (AF).Nine patients with antiarrhythmic drugs refractory AF underwent PVs isolation during sustained AF.Mapping of PVs was performed with a circumferential mapping catheter.If the acti vity inside the PVs was organized with one or multiple kinds of consistent activ ation sequence,radiofrequency (RF) ablation was performed by targeting the earli est activity.When PV activation was disorganized or without a definite activatio n sequence,ablation was performed anatomically around the PV perimeter with a ul trasound balloon catheter until complete isolation of the PV or the PV activity allowing secondarily a more localized targeting with a RF catheter.Results:In to tal 28 PVs were ablated during AF,and complete electrical isolation was achieved in 26 of them (92.9%).The total procedure duration and fluoroscopy times were 1 38±21 min and 38±9 min,respectively.There were no PVs stenosis or other compli cations in this study.After a mean follow up of 6.3±2.9(3～11)months,4 patie nts (44.4%) were AF free without antiarrhythmic drugs.Conclusions:Isolation of m ultiple PVs during sustained AF is feasible and safe.Combined ultrasound balloon ablation and RF ablation had a high efficacy in PVs isolation during ongoing AF .[ Chinese Journal of Cardiac Pacing and Electrophysiology, 2003,17(1):27～30