阵发性心房颤动射频消融术成功终点评价的研究  

The study of successful radiofrequence ablation endpoint assessment for the patients with paroxysmal atrial fibrillation

作　　者：李学斌[1] 郭继鸿[1] 张萍[1] 张海澄[1] 许原[1] 贾忠伟[1] 

机构地区：[1]北京大学人民医院心内科,100044

出　　处：《中国介入心脏病学杂志》2004年第4期211-214,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的　在术后停用抗心律失常药物的情况下 ,评价阵发性心房颤动 (房颤 )患者射频消融术根治的效果。方法　顽固性阵发性房颤患者 32例 ,于射频消融术前 1周停用抗心律失常药物 ,并隔日行 2 4小时动态心电图检查 ,共 4次。观察患者术前房性心律失常的发作特点 ,评价阵发性房颤的发作频度等。术中对靶血管明确者 ,行靶肺静脉电隔离术。靶血管不明确者 ,则对所有肺静脉行电隔离术和右心房峡部双向阻滞治疗。术后停用所有抗心律失常药物 ,于术后第 1、3、5、7天行 12导联 2 4小时动态心电图检查 ,如果 7～ 10d仍有反复发作 ,则再次行射频消融治疗。所有患者至少随访3个月。结果　 15例患者术中能明确靶血管 ,首次根治成功率为 6 0 0 % (9/ 15 ) ,6例复发 ,再次手术后全部成功。未能明确靶血管者 17例 ,首次根治成功率为 4 7 0 % (9/ 17) ,再次手术后成功率达 5 8 8%(10 / 17) ,第三次手术后成功率达 6 4 7% (11/ 17)。全部病例共隔离肺静脉 82根 ,其中因标测到明确靶血管并成功肺静脉电隔离者 17根 ,盲目肺静脉电隔离 6 5根 ,行右房峡部双向阻滞者 18例。平均手术次数 1 35次 ,总治愈率 81 3%。结论　在完全停用抗心律失常药物情况下观察射频消融术的终点 ,表明消融术对靶血管明确的患者成功率最高 ,对术?Objective To evaluate the efficacy of the end point of catheter ablation of pulmonary vein (PV) foci initiating atrial fibrillation (AF) to guide the catheter ablation of PAF Methods Thirty two drug resistant PAF patients withdrew all antiarrhythmias drugs for one week and received Holter monitoring on dyas 7, 5, 3, and 1 before operation, respectively During the operation, focal ablation was performed in the patients whose target PV could be documented, and all pulmonary veins os and isthmus of right atrium were ablated in the other patients All patients received Holter monitor on days 1,3,5, and 7 postablation, respectively If PAF relapsed after the first operation, the patient would undergo operation again until no AF was documented The patients were followed up for 3 to 20 months Results Total 82 PV in 32 patients were success isolated In foci ablation patients, 9(60 0%) patients successed by one operation, and 6(40 0%) patients successed after the second operation In all PVs isolation patients, 9(47 0%) patients successed by one operation, and 10 (58 8%) patients successed after the second operation, and the success rate was 11 (64 7%) after the third operation The overall success rate was 81 3% Conclusion The endpoint of PAF ablation should be no AF recurrence when no antiarrhythmias drugs were administrated The success rate was higher in the patients who had clear target PV and the overall success rate could be improved by the ablation once again

关 键 词：靶血管 患者 射频消融术 术后 根治 抗心律失常药物 肺静脉电隔离 成功率 阵发性心房颤动 反复发作 

分 类 号：R541[医药卫生—心血管疾病] R473.6[医药卫生—内科学]