大静脉电隔离后阵发性心房颤动复发的原因和再消融治疗

探讨阵发性心房颤动 (简称房颤 )复发的原因以及再次电隔离治疗的安全性和疗效。选择行电隔离后经动态心电图证实阵发性房颤复发且症状明显和药物治疗无效的患者 ,择期行再次心内标测和电隔离治疗 ,术中对已作电隔离和未电隔离的大静脉和上腔静脉逐一进行标测 ,对存在静脉 心房传导的大静脉再次行射频消融电隔离。结果 :30例房颤复发的患者共进行 6 3次心内标测和电隔离。其中 2次电隔离 2 7例 ,3次电隔离 3例 ;第一次电隔离大静脉 80根 ,再次标测显示其中有 75支 (93.8% )的大静脉电位完全或部分恢复。第二次和第三次共电隔离大静脉 1 0 2支 ,其中肺静脉 94根、上腔静脉 8根 ,有 5根房颤复发靶大静脉为第一次未进行消融的大静脉。术后随访2 38± 1 82天 ,无房颤复发 2 1例 (70 % )。出现并发症 5例 (1 6 .7% ) ,其中肺静脉狭窄 3例 (1 0 % )、一过性脑卒中 1例、心包压塞 1例。结论 :静脉 心房传导恢复可能是房颤复发的主要原因 ,对复发病例 ,再次电隔离仍然有效 ,但有较高的并发症发生率

Repeat Mapping and Isolation of Veno-Atrial Electrical Connections in Recurrent Cases of Paroxysmal Atrial Fibrillation

We investigated the eletrophysiological characteristics and the results of repeat mapping and isolation of pulmonary veins (PV) and superior vena cava (SVC) in patients with recurrent paroxysmal atrial fibriallation(PAF). Results: A total of 63 procedures were performed in 30 patients with recurrent PAF, including second procedures in 27 and third procedures in 3 patients. Repeat electrophysiological mapping studies showed that there were 75 of 80 (93.8%) isolated veins exhibiting complete (65.0%) or partly (28.8%) recurrences of vein potentials. Repeat mapping showed that the arrhythmogenic veins were the non targeted veins in the previous procedures in five patients. Electrical isolation were then attemped in 102 veins including 94 pulmonary veins and 8 superior vena cava, with the achievement of electrical disconnection in 93 veins (91.2%). During 238±182 days following up, 21 (70%) cases were free of PAF without medication, and the another two patients experienced remarkable reduction of PAF episodes. The complications occurred in 5 patients (16.7%), including pulmonary vein stenosis in 3, stroke in 1 and cardiac tamponade in 1. Conclusion: Conduction recurrence across disconnecting radiofrequency lesions may contribute significantly to the recurrence of PAF in patients undergoing electrical isolation. Repeat mapping and isolation of the PV and SVC is effective in patients with PAF recurred after veno atrial electrical isolation, but more caution needed to avoid the complications.