肺静脉间嵴消融在环肺静脉线性隔离术中的作用

目的研究肺静脉间嵴消融在环肺静脉线性隔离术中所起的作用。方法共124例阵发性心房颤动(简称房颤)患者在电解剖标测和CT图像整合技术的指导下行环肺静脉线性消融术。手术的终点为肺静脉隔离。环肺静脉消融线完成后,在原消融线径上寻找可能存在的传导"gap"进行补充消融,如反复消融依然无法达到肺静脉隔离者,根据环状标测电极显示的最早肺静脉电位,在消融环线以内肺静脉口处进行节段性消融以实现肺静脉隔离。结果共41.1%的左侧肺静脉和11.3%的右侧肺静脉需在消融环线以内行节段性消融才达到电学隔离,其中左肺静脉节段隔离部位多见于左侧肺静脉间嵴前部;右侧肺静脉节段隔离部位多见于右侧肺静脉间嵴中后部。结论行环肺静脉线性消融的患者中,一部分需要在肺静脉间嵴处消融以提高肺静脉隔离的成功率。

The role of pulmonary vein carina ablation in the strategy of circumferential pulmonary vein isolation

Objective To analyze the important role of pulmonary vein earina ablation in the strategy of circumferential pulmonary vein isolation. Methods One hundred and twenty-four patients with paroxysmal atrial fibrillation who underwent circumferential pulmonary vein ablation （ CPVA ） guided by electroanatomic mapping and CT integration （ CartomergeTM） were enrolled in this study. The endpoint of CPVA was pulmonary vein isolation （PVI）. All patients underwent one round of CPVA and then were carefully checked for the presence of gaps on the ablation line which were subsequently targeted by ablation. The patients in whom the pulmonary vein potentials still persisted underwent ablation inside the circumferential ablation line at the ostium of pulmonary vein according to the earliest PV breakthrough on the circular mapping catheter. Results To achieve PVI , the segment ablation was necessary inside the circumferential ablation line at the left pulmonary vein in 41.1% and at the right pulmonary vein in 11.3% of patients. On the left, immediate PVI sites were predominantly on the anterior part of pulmonary vein earina. On the right, immediate PVI sites were predominantly on the middle and posterior part of puhnonary vein carina. Conclusion Pulmonary vein carina ablation is advisable to increase the PVI efficacy in a significant proportion of patients underwent CPVA . [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2010,24 （ 4 ） ：325 - 328 ]