心房颤动消融术中肺静脉传导恢复的识别及再干预对疗效的影响

目的观察阵发性心房颤动(房颤)环肺静脉电隔离术(CPVI)中不同观察时间内肺静脉传导急性恢复的发生率,并评价再次电隔离术对于临床疗效的影响。方法入选阵发性房颤患者90例,其中男性51例,女性39例,平均年龄56·4±12·3(45～73)岁;随机分为三组行CPVI,组A实现肺静脉电隔离不予观察,组B电隔离后观察时间30min,组C电隔离后观察时间60min,评价肺静脉传导恢复发生率并对其再次行电隔离术。术后随访心电图和24小时动态心电图评价疗效。结果所有患者顺利完成消融术。组A平均手术时间显著短于组B和组C。肺静脉隔离时间和X线透视时间三组中每两组差异均无统计学意义。组B左肺静脉隔离后30min传导恢复8例(25%),60min电位恢复共10例(31·2%);右肺静脉隔离后30min传导恢复6例(18·8%)。组C左肺静脉隔离后30min传导恢复9例(30%),60min传导恢复共11例(36·7%);右肺静脉隔离后30min7例(23·3%)传导恢复,60min共8例(26·7%)传导恢复。平均随访6·7±2·3(4～9)个月,组A17例(60·7%)、组B27例(84·3%)、组C26例(86·7%)无房性快速性心律失常发作,P=0·04。结论环肺静脉电隔离术中肺静脉传导急性恢复率为30%左右,多数发生在肺静脉隔离后30min内,再次电隔离术有助于提高消融成功率。

Effect of identification and treatment of early pulmonary vein re-connection on clinical results of atrial fibrillation ablation

Objective To investigate the prevalence of acute pulmonary vein(PV) conduction recovery during observation time after PV isolation for paroxysmal atrial fibrillation(AF),and to evaluate the impact of re-isolation treatment on clinical results.Methods Ninety cases with paroxysmal AF(51 males,mean age of 56.4 12.3 years) were randomized to 3 groups to undergo circumferential pulmonary vein isolation(CPVI).In group A there was no observation time post-ablation.In group B there was 30 minutes for observation time post-ablation and in group C,there was 60 minutes of observation time post-ablation.All PV re-conduction was re-isolated at the end of observation.ECG and Holter were performed to evaluate the clinical effectiveness of the ablation.Results All cases underwent the procedure successfully.The mean procedural time in group A was significantly shorter than in group B and group C,but there was no significant difference on fluoroscopic time and PV isolation time among the three groups.In group B,PV re-conduction occurred in 8 cases(25%) at 30 min post-isolation,in 10 cases(31.2%) at 60 min post-isolation for the left PVs,and in 6 cases(18.8%) at 30 min post-isolation for the right PVs.In group C,PV re-conduction occurred in 9 cases(30%) at 30 min post-isolation and in 11 cases(36.7%) at 60 min post-isolation for the left PVs;for the right PVs,re-connection occured in 7 cases(23.3%) at 30 min post-isolation and in 8 cases(26.7%) at 60 min post-isolation.During a mean follow-up of 6.7 2.3 months,17 cases(60.7%) in group A,27 cases(84.3%) in group B,and 26 cases(86.7%) in group C had no recurrence of atrial tachyarrhythmias,P=0.04.Conclusion The prevalence of acute PV conduction recovery was about 30% after PV isolation,which mostly occurred within 30 minutes after initial isolation.Re-isolation of recovered PV conduction may improve the success rate of ablation for paroxysmal AF.