应用带有标测功能的冷冻球囊进行肺静脉电隔离

目的 研究应用带有微型环肺静脉标测导管（微环导管）的冷冻球囊完成肺静脉电隔离的可行性.方法 入选2007年12月至2013年3月在德国心脏中心（柏林）接受导管消融的202例阵发性心房颤动（房颤）患者.1次房间隔穿刺后,将冷冻球囊置入左心房.冷冻球囊中央管中放置1根微环导管,作为“导引钢丝”和肺静脉标测导管.结果 电隔离751根肺静脉.其中405根肺静脉（53.9％）在冷冻消融过程中,实时记录到肺静脉电位消失;346根肺静脉（46.1％）在冷冻消融后,回撤微环导管,证实肺静脉电隔离.平均手术时间（131.4±51.7） min,X线曝光时间（23.7±11.3） min.随访33.4（6～63）个月,131例（64.9％）患者无房颤发作.1例患者在隔离右上肺静脉时出现膈神经麻痹,1个月后恢复.结论 使用带有标测功能的冷冻球囊进行肺静脉电隔离是有效、可行的.

Pulmonary vein isolation using cryoballoon catheter with mapping electrode

Objective This study aims to evaluate the feasibility and efficacy of a simplified cryoballoon technique in which a microcircular catheter was introduced into the central lumen of a cryoballoon catheter for the purpose of recording pulmonary vein（PV） potentials during ablation procedures and without interchanging catheters.Methods A total of 202 consecutive patients with paroxysmal atrial fibrillation （AF） were enrolled.A single transseptal puncture was made and a cryoballoon catheter was inserted into the left atrium.A 6pole mapping catheter with a 0.035-inch shaft diameter was introduced into the PV through the central lumen of the cryoballoon catheter.In addition to the function as a recording device,the mapping catheter was also used as a ‘guide-wire＆#39; during the procedure.Results A total of 751 PVs were completely isolated using this novel cryoballoon technique.Isolation was observed in real time in 405 veins（53.9%）during the cryoablation.The remaining 346 veins（46.1%） isolation was confirmed immediately post ablation attempt with the mapping catheter.The mean procedure time was（131.4±51.7） min,and fluoroscopy time was（23.7±11.3） min.At follow-up（33.4 months,range 6-63 months）,131 （64.9%） patients were free from AF.There was one occurrence of phrenic nerve palsyduring ablation of a right superior PV,which fully resolved after one month.Conclusion The use of a cryoballoon catheter equipped with a 6-pole micromapping catheter inserted through its central lumen for the purpose of mapping and ablation during PV isolation procedures is both feasible and effective.