节段性肺静脉电隔离治疗阵发性心房颤动的方法学

目的 对阵发性心房颤动(房颤)经药物治疗无效并接受射频导管消融治疗的患者，采用经改良的节段性电隔离方法隔离肺静脉进行治疗，并研究该方法的有效性及安全性。方法 61例阵发房颤患者采用一次房间隔穿刺技术，分别送入标测及消融电极导管。应用猪尾造影导管用高压注射器非选择性左心房造影显示肺静脉开口及左心耳位置，指导导管行进方向以减少心脏压塞风险。标测中常规探查、标测右下肺静脉，避免遗漏可能触发房颤的肺静脉电位。在肺静脉与左心房之间肺静脉电位优势传导部位用温控导管或冷盐水灌注导管做多点消融形成节段性隔离。结果 单个节段或多个节段消融可使肺静脉与左心房之间形成完全性电隔离，使肺静脉电位消失。节段性隔离靶肺静脉173根，即刻成功168根，成功率97．1％。术中2例发生心脏压塞，1例左上肺静脉狭窄60％。结论 节段性电隔离肺静脉法可有效隔离肺静脉，可替代点状隔离和环状隔离方法。与其他传统方法比较，手术时间短、成功率高，可明显减少肺静脉的损伤和避免肺静脉狭窄的发生。

The methodological study of segmental isolation of pulmonary veins in patients with paroxysmal atrial fibrillation

Objective The present study sought to investigate the efficacy and safety of the method of improved segmental electrical isolation of pulmonary veins (PVs)in patients with paroxysmal atrial fibrillation (PAF).Methods Sixty-one patients with recurrent documented symptomatic PAF were included.In order to avoid the risk of cardiac tamponade,we adopted one transseptal procedure and obtained unselective angiography of all PVs and left atrial appendage using a pig tail catheter .Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum.Right inferior PV was routinely being mapped in order to not miss any pulmonary vein potential (PVP)that might trigger PAF.RFCA was applied at the PVP breakthrough to perform segmental electriacl isolation of pulmonary veins using therom-control or irrigated RF catheter.Results Complete segmental electrical isolation of pulmonary veins may be achieved by RF applications at one or multiple sites of the PV ostium.173 PVs were targeted for segmental RFCA,168 PVs were isolated completely.Immediately success rate was 97.1%.There were 2 cases with cardiac tamponade and 1 case with 60% stenosis of the right superior PV associated with the procedure.Conclusion It is suggested that the method of segmental PV isolation is effective and can substitute focal RF and circular isolafion of PVs.It has higher success rate and shorter procedure time compared with other traditional methods .It can minimize the lesion of pulmonary veins and avoid PV stenosis.