射频导管消融治疗肺静脉相关的心房颤动合并其他类型快速心律失常  

Radiofrequency catheter ablation of pulmonary vein related paroxysmal atrial fibrillation associated with other tachyarrhythmias

作　　者：杨东辉[1] 黄丽萍[1] 杨延宗[1] 刘少稳[1] 高连君[1] 夏云龙[1] 李世军[1] 林治湖[1] 

机构地区：[1]大连医科大学附属第一医院心内科,116011

出　　处：《中华心律失常学杂志》2004年第4期219-222,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金 ( 3 0 2 70 5 5 2 )

摘　　要：目的　总结 9例肺静脉相关的阵发性心房颤动 (PAF)合并其他类型快速心律失常的电生理特点和射频导管消融治疗的经验。方法　 9例PAF患者 ,男性 6例 ,女性 3例 ,年龄 2 2～ 6 2(4 9 8± 12 5 )岁 ,PAF病史 3个月～ 10年。其中 3例合并预激综合征 ,2例成功阻断旁路传导 ,1例失败 ;2例合并房室结折返性心动过速 ,成功消融房室结慢径 ;3例合并的室性心律失常均起源于右心室流出道 ,2例导管消融成功 ,1例未消融 ;3例术前有典型心房扑动 (AFL)发作 ,行右心房峡部消融实现双向阻滞。经上述消融后 ,各病例仍有频繁PAF发作 ,电生理检查发现肺静脉异位冲动触发PAF发作。 8例进行了心脏大静脉电隔离 ,1例在电隔离后出现典型AFL发作 ,行右心房峡部消融成功。结果　随访 7～ 2 5个月 ,7例无PAF发作 ,2例仍有频发房性早搏和PAF发作 (包括未行肺静脉电隔离 1例 ) ,其他成功消融的室上性和室性心律失常无复发。结论　成功消融房室旁路、房室结慢径、右心房峡部、室性心律失常后不能消除或减少肺静脉相关的PAF发作 ,几种心律失常并存可以先后消融成功。肺静脉相关的PAF特点突出 ,旁路、双径路、典型AFL。Objective To study the electrophysiological characteristics of 9 cases of pulmonary vein (PV) related paroxysmal atrial fibrillation (PAF) associated with other tachyarrhythmias and to report the results of radiofrequency catheter ablation of them.Methods Nine patients [male 6,female 3,mean age (49.8±12.5) years] with PV related PAF were enrolled in this study.Their symptoms owing to PAF lasted for 3 months to 10 years.Atrioventricular accessory pathway (AP) was found in 3 patients,and 2 were ablated successfully.Atrioventricular node reentry tachycardia (AVNRT) was found in 2 patients,and in both the slow pathway were ablated successfully.And 2 of 3 cases of ventricular arrhythmias originating from the right ventricular outflow tract (RVOT) were eliminated successfully.And all of 3 cases of typical atrial flutter (AFL) underwent isthmus ablation of right atrium and revealed bi-directional block.PAF still presented after the above mentioned ablation procedures.And electrophysiological studies confirmed that the PAF was triggered by the ectopic beats originated from PVs.PVs and/or superior vena cava were then isolateted electrically with radiofrequency energy in 8 patients.Results One case of typical AFL presented after the PAF ablation procedure then underwent linear ablation of the isthmus of the right atrium.During a follow-up of 7～25 months,7 patients were free of PAF,and other associated arrhythmias did not recur in all 9 patients.Conclusions PV related PAF is independent of AP,AVNRT,ventricular arrhythmias from RVOT or AFL in this group of patients.These arrhythmias could be ablated one by one.

关 键 词：PAF 发作 射频导管消融 肺静脉 治疗 室性心律失常 峡部 右心房 快速心律失常 慢径 

分 类 号：R541.7[医药卫生—心血管疾病]