应用心腔内超声指导局灶性心房颤动的射频消融

探讨在心腔内超声 (ICE)导引下对局灶性心房颤动 (简称房颤 )行射频消融治疗的可行性和安全性。选择 4例阵发性房颤而无器质性心脏病的患者 ,在 ICE指导下根据电生理检查的定位结果分别在左房的左上肺静脉、右上肺静脉及右房终末嵴上部进行射频消融。消融能量为 3 0 W,消融温度为 60℃ ,放电时间 87～ 12 0 s。结果 :右房内超声均可在单幅影像下动态显示卵圆窝、主动脉、左房 ,穿刺房间隔时可避免误穿主动脉或穿刺针过深穿破左房。左房内超声可显示肺静脉及其分支的内部结构以及导管与内壁的贴靠紧密与稳定程度。 1例术中房颤终止 ,术后 1天复发 ;2例消融后房早消失 ,随访一周无房颤复发 ;1例术中消融后可诱发房颤但随访半年无房颤发作。结论 :在ICE导引下对局灶性房颤进行射频消融 ,能增加安全性和可靠性 ,是一种较有前途的方法。

Radiofrequency Ablation of Focal Atrial Fibrillation Under the Guidance of Intracardiac Echocardiography

This study tested the feasibility and safety of radiofrequency (RF) catheter ablation in eliminating focal atrial fibrillation (AF) under the guidance of intracardiac echocardiography (ICE).Four patients with paroxysmal AF and normal heart underwent RF catheter ablation in left and right pulmonary veins and upper portion of cristal terminalis respectively under ICE.Radiofrequency energy was delivered at 30 W,temperature 60℃,duration of 87-120 seconds.Results:AF was terminated during procedure and recurred next day in one case.The premature atrial complexes disappeared during procedure and no recurrence for one week in two cases.AF could initiated after ablation but no symptomatic recurrence for half year in one case.Conclusion:ICE increases the safety and reliability of RF catheter abaltion of focal atrial fibrillation.Focal ablation under ICE may be a promising method for the treatment of atrial fibrillation.