肺静脉前庭隔离联合左心房线性及碎裂电位消融治疗持续性心房颤动的临床研究

目的探讨肺静脉前庭隔离联合线性及碎裂电位消融治疗持续性心房颤动（房颤）的有效性与安全性。方法共45例持续性房颤患者入选本研究（其中长时程持续性房颤28例）,男性32例,女性13例,年龄（58.8±9.0）岁,病程（23.3±22.4）个月。消融步骤是先行肺静脉前庭隔离,后行线性消融,最后行心房碎裂电位消融。术后所有患者均给予服用培哚普利4 mg/d和抗心律失常药物3个月。甲状腺功能异常者,给予普罗帕酮450 mg/d,共3个月;术前未用胺碘酮者,术后即刻静点胺碘酮1 mg/min,6 h后减量为0.5 mg/min维持42 h,同时口服0.6 g/d连续1周,继之0.4 g/d连续1周,以后0.2 g/d,共3个月;术前口服胺碘酮患者,术后继续口服,0.2 g/d,共3个月。结果消融术中有9例房颤终止,2例先转变为三尖瓣峡部依赖性心房扑动,峡部消融后转为窦性心律（窦律）;3例转为房性心动过速（房速）,最早激动点或者关键峡部消融后转复为窦律;其余患者均行电复律转复为窦律。平均随访（18.2±9.2）个月,共12例患者发作房性心律失常;复发房颤3例,房速9例。结论持续性房颤患者,肺静脉前庭隔离联合左房线性及碎裂电位消融能够破坏更多的维持机制,是治疗持续性房颤的安全、有效的方法。

Clinical study of pulmonary vein atrium isolation combined with left atrial linear ablation and complex fractionated atrial electrograms ablation in treating persistent atrial fibrillation

Objective To evaluate the clinical efficacy and safety of pulmonary vein atrium isolation combined with left atrial linear ablation and complex fractionated atrial electrograms ablation in treating persistent atrial fibrillation（AF）.Methods Forty-five persistent AF patients（including 28 long-standing persistent AF patients,32 men,13 women,mean age（56.5±9.0） years were included in the study.The mean AF history of the studied patients was（23.3±22.4） months.The ablation procedure was as follows.Pulmonary vein atrium isolation（PVAI） was first applied,followed by linear ablation.Finally complex fractionated atrial electrograms（CFAEs） ablation was conducted.All patients took admidarone（4 mg/d） and anti-arrhythmic drugs for three months.Propafenone（450 mg/d） was given to those with thyroid gland dysfunction.Those who did not take amiodarone before surgery immediately took intravenous amiodarone after surgery（1 mg/min first,reduced to 0.5 mg/min 6 h later,continued for 42 h;oral intake 0.6 g/d,continued for 1 week,0.4 g/d for another week,0.2 g/d later on,lasted for 3 months）.Those who had amiodarone before surgery continued after surgery（0.2 d/d for three months）.Results AF terminated in 9 patients.Among them,two patients first had atrial flutter and then changed to sinus rhythm.Three patients had focal atrial tachycardia.The rest patients changed back to sinus rhythm after cardioversion.A follow-up of（18.2±9.2） months was conducted.Results showed that 12 patients had atrial arrhythmia,3 had AF and 9 had focal atrial tachycardia.Conclusion Pulmonary vein atrium isolation combined with left atrial linear ablation and complex fractionated electrograms ablation is safe and effective in treating persistent AF.