典型心房扑动合并阵发性心房颤动射频消融治疗方法选择

目的对比观察单纯右房峡部消融,单纯肺静脉节段性电隔离以及联合应用两种消融方法对典型心房扑动(房扑)合并阵发性心房颤动(房颤)的临床疗效。方法典型房扑合并阵发性房颤患者66例,行单纯右房峡部消融30例(A组),行单纯肺静脉节段性电隔离17例(B组)及二种消融方法联合治疗19例(C组)。术后临床随访平均30.5周±10.4周,观察心律失常复发率及手术的并发症。结果房扑复发率在术后12周A组(13.3%)和C组(10.5%)明显低于B组(52.9%)(均P<0.05),A组与C组间差异无统计学意义(P>0.05);术后36周3种消融方法间(A、B、C组分别为10%、11.8%、10.5%)差异无统计学意义(均P>0.05)。房颤复发率在术后12周至36周B组(分别为29.4%和23.5%)和C组(分别为31.6%和26.3%)均明显低于A组(分别为46.7%和73.3%)(均P<0.05),而B组与C组间差异无统计学意义(P>0.05)。结论典型房扑合并阵发性房颤单纯行右房峡部消融对房扑效果好,而房颤复发率较高;单纯行肺静脉节段性电隔离在房颤得到根治的同时,房扑亦得到良好的控制;肺静脉节段性电隔离同时行右房峡部消融,仅减少早期房扑复发,长期随访观察未显示其优势。

Effects of different catheter ablation strategies in treatment of typical atrial flutter complicated with paroxysmal atrial fibrillation

OBJECTIVE: To evaluate the clinical effects of different catheter ablation strategies in the treatment of typical atrial flutter complicated with paroxysmal atrial fibrillation (PAF). [CTIA, pulmonary vein segmental isolation (PVSI), CTIA + PVI] to the patients coexisted with typical atrial flutter and PAF. METHODS: 66 patients with typical atrial flutter complicated with PAF were divided into 3 groups: Group A (n = 30), undergoing cavotricuspid isthmus ablation, (CTIA), Group B (n = 17), undergoing pulmonary vein segmental isolation, (PVSI), and Group C (n = 19), undergoing CTIA + PVSI. Follow-up was conducted for 30.5 weeks +/- 10.4 weeks. The clinical curative effects, operation safety, and complication were evaluated. RESULTS: The recurrence rate of typical atrial flutter within 12 weeks after operation of Groups A and C were 13.3% and 10.5% respectively, both significantly lower than that of Group B (52.9%, both P < 0.05) without no significant difference between Group A and Group C (P > 0.05). The recurrence rate of typical atrial flutter within 36 weeks after operation of the Groups A, B, and C were 10%, 11.8%, and 10.5% respectively, without significant differences among these 3 groups (all P > 0.05). The recurrence rates of PAF within 12 weeks and 30 weeks after operation of Groups B and C were 29.4% and 31.6%, and 23.5% and 26.3% respectively, all significantly lower than those of Group A (46.7% and 73.3% respectively, all P < 0.05) without significant o differences between Groups B and C. CONCLUSION: In patients with both typical atrial flutter and PAF, pure CTIA has a good effect on typical atrial flutter, whereas the PAF recurrence rate is higher; Pure PVSI has a good control of typical atrial flutter while curing PAF; PVSI + CTIA only reduces the early recurrence of typical atrial flutter, however, has no advantage in long-term follow up.