肺静脉异常电活动引起持续性心房颤动的电生理特点和消融治疗

目的　报道 4例肺静脉异常电活动引起持续性心房颤动 (房颤 )的电生理特点和消融治疗。方法　 4例患者的临床表现和心电图记录提示为持续性房颤。经股静脉和锁骨下静脉穿刺置入高位右房 (HRA)和冠状静脉窦 (CS)电极 ,并行房间隔穿刺和肺静脉造影 ,置入 10极环状电极 (Lasso电极 )进行各肺静脉标测。观察自发和诱发房颤时的心腔各部位局部电活动的周期及规则性 ,以局部异常电活动出现最早、持续异常电活动最紊乱的肺静脉作为靶肺静脉。在房颤持续时消融电隔离靶肺静脉至左房连接处 ,以房颤终止和异常电活动消失为消融终点。结果　 4例患者异常电活动起源于右上肺静脉 (3例 )和左上肺静脉 (1例 )。靶肺静脉局部电活动频率快且不规则 ,间断出现短阵性周期缩短。靶肺静脉口部消融分别于放电 1～ 18次时房颤终止 ,3例伴有异常电活动终止 ,1例肺静脉内仍显示快速异常电活动 ,经肺静脉内局灶消融后电活动终止。随访 4～ 17个月 ,无房颤复发。结论　肺静脉内异常电活动是部分持续性房颤的发生机制 ,射频消融肺静脉口部可隔离和消除异常电活动而终止房颤

The electrophysiological characteristics and ablation treatment of patients with paroxysmal sustained atrial fibrillation caused by rapid focal activation originating from the pulmonary veins

Objective To report the electrophysiological characteristics and ablation treatment of four patients with sustained atrial fibrillation originating from pulmonary veins. Methods Four patients with frequent episodes and ECG recording of atrial fibrillation were involved in this study. Two multiple electrode catheters were placed in the high right atrium (HRA) and coronary sinus (CS) for mapping and stimulation. Two decapolar ring designed catheters (Lasso mapping catheter, Cordis Co) were positioned into the pulmonary veins (PV) for mapping of the activation after atrial transseptal puncture and angiography of PV. The cycle length and regularity of the local activation were measured at the bipolar electrograms from HRA, CS and PVs during spontaneous or induced atrial fibrillation. The target pulmonary vein was that where the earliest activity was appeared at the onset of atrial fibrillation or the most irregular activity was recorded during atrial fibrillation. Radiofrequency energy was delivered at the junctions of the target PV and left atrium during atrial fibrillation. The endpoint of procedure was the termination of atrial fibrillation and disappearance of focal activity from PV. Results The rapid focal activation was originated from right superior (3 patients) and left superior (1 patient) PV. Target PV had rapid and irregular activation which had frequent episodes of cycle length shortening. In four patients the atrial fibrillation was terminated during 1 to 18 delivering, and in three of them the rapid activity disappeared at the same time of atrial fibrillation termination. In another patient with the rapid activation from PV during sinus rhythm the focal activity disappeared after PV focal ablation. No recurrence of atrial fibrillation during follow up of 4 to 17 months. Conclusions It could be concluded that focal activity originated from PV was an important mechanism of paroxysmal atrial fibrillation. Radiofrequency energy ablation to the ostium of target PV could isolate the activity from PV to left atrium or abolish the focal activity to terminate atrial fibrillation.