三维标测系统指导心房颤动导管消融的临床研究  

Clinical study of catheter ablation for atrial fibrillation guided by 3 dimensional mapping system

作　　者：胡雪松[1] 裴晓阳 徐亚伟[2] 于学靖[2] 张新霞[1] 颜雯 闵敏 

机构地区：[1]深圳市第四人民医院心内科,广东深圳518033 [2]上海市第十人民医院,上海200072

出　　处：《岭南心血管病杂志》2009年第4期291-294,共4页South China Journal of Cardiovascular Diseases

基　　金：深圳市卫生局科技项目(项目编号:302);深圳市福田区公益科研项目

摘　　要：目的探讨三维标测系统指导下导管射频消融治疗心房颤动的有效性与安全性。方法回顾性分析39例在三维标测系统指导下行环肺静脉线性消融术的心房颤动患者(其中阵发性心房颤动33例和持续性心房颤动6例)的临床资料,着重分析术前准备、标测及消融方法、手术结果、术后治疗和随访。结果消融终点为Lasso标测的所有肺静脉均达到完全电学隔离,若消融结束后心房颤动仍未终止,即行同步直流电复律恢复窦性心律。39例患者共完成78条环形消融线,肺静脉完全电学隔离率为93.6%(73/78)。手术操作时间为(245±56)min、X线曝光时间为(46±15)min。术后随访6个月～12个月,33例临床症状得到改善,无心房颤动复发,6例需服用抗心律失常药维持窦性心律,其中3例心房颤动复发患者接受再次导管消融后无发作。射频消融术后总成功率为84.6%(33/39)。结论三维标测系统指导下导管射频消融治疗心房颤动是安全和有效的治疗方法。Objectives To investigate the efficacy and safety of catheter ablation for atrial fibrillation (AF) guided by 3 dimensional mapping system. Methods The clinical data of 39 patients with AF ( 33 paroxysmal AF, 6 persistent AF) and received pulmonary vein ( PV) isolation with circumferential PV linear ablation guided by 3 dimensional mapping system (CARTO) were retrospectively analyzed. We focused on analyzing the preparation of the operation, methods of mapping and ablation, results of the operation and the follow-up. Results The procedural end-point was an complete electrical isolation of all PV confirmed by Lasso catheter. A direct current cardioversion was given for the patients with AF at the end of the procedure. Seventy-eight anatomically guided linear lesions around ipsilateral PVs were performed in all cases and PV isolation rate was 93.6% ( 73 / 78). Mean procedure time was (245±56) min. Mean fluoroscopy time was (46±15) min. After a follow-up of 6 to 12 months, the overall success rate was 84.6% (33 / 39). Thirty three patients improved clinically and remained AF free. Six required antiarrhythmic medications to maintain sinus rhythm and 3 of them with recurrent AF didn't recur after a repeat ablaion. Conclusions Catheter ablation for AF guided by 3 dimensional mapping system is a feasible and effective method for treating AF.

关 键 词：心房颤动 导管消融术 肺静脉 治疗效果 

分 类 号：R541.7[医药卫生—心血管疾病]