以终止持续性心房颤动为手术终点的递进式消融200例总结

目的总结递进式消融术式治疗持续性心房颤动(简称房颤)的手术过程及临床转归。方法采用递进式消融策略治疗连续200例持续性房颤患者,手术终点为通过单纯消融终止房颤。按以下顺序进行消融:环肺静脉前庭消融达肺静脉电学隔离;心房碎裂电位消融;左房顶部和二尖瓣环峡部线性消融;针对房颤转变而成的房性心动过速(简称房速)行激动标测结合拖带技术明确其机制,并进一步消融终止。经术后3个月空白期,对复发房性心律失常(房颤/房速)的患者进行再次消融。结果 136例患者(68%)术中房颤被消融终止,消融终止房颤组首次术后房性心律失常复发率显著低于未终止组[19.9%(27/136)vs 51.6%(33/64),P<0.01],复发患者经再次消融后,平均随访12.8±7.2个月,本组病例总体手术成功率78.5%(157/200)。消融终止房颤组手术总体成功率高于未终止组[(86.8%(118/136)vs 60.9%(39/64),P<0.01)]。结论递进式消融可能是治疗持续性房颤的一种有效术式。

The summation of step-wise ablation in 200 persistent atrial fibrillation cases using termination as a procedural endpoint

Objective To summarize the process and clinical outcome of step-wise ablation in persistent atrial fibrillation(AF) cases using termination as a procedural endpoint.Methods Two hundred consecutive patients underwent catheter ablation of persistent AF using a stepwise approach with the desired procedural endpoint being AF termination.Ablation was performed in such a sequence : Circumferential ablation of pulmonary veins to achieve isolation;Ablation at sites possessing complex fractionated atrial electrograms;linear ablation of the left atrium roof and mitral isthmus;If AF changed into atrial tachycardia(AT),activation mapping and entrainment maneuvers were used to define the mechanisms of the tachycardias,then ablation was performed to terminate the tachycardia.Repeat ablation was performed for patients with recurrent atrial arrythmias after a 3 month blanking period.Results AF was terminated in136 patients(68%).There was a lower incidence of atrial arrythmias(AF/AT)in those patients in whom AF was terminated during the index procedure compared with those who had not [19.9%(27/136) vs 51.6%(33/64),P<0.01].After repeat ablation,at 12.8±7.2 months of follow-up,the total success rate of the procedure was 78.5%(157/200).Sinus rhythm was maintained in 86.8%(118/136) in whom AF was terminated compared with 60.9%(39/64) in those in whom AF could not be terminated(P<0.01).Conclusion Catheter ablation using the step-wise approach may be an effective way for treating persistent AF.