Carto系统指导下左房电解剖隔离治疗心房颤动  

The Left Atrial Line ar Ablation for Curing Atrial Fibrillation by Using the Electroanatomical Mappin g System

作　　者：殷跃辉[1] 佘强[1] 刘增长[1] 兰先彬[1] 刘东[1] 杨晓谕[1] 吴近近[1] 董军[1] 

机构地区：[1]重庆医科大学附属第二医院心血管内科重庆市心律失常治疗中心,重庆400010

出　　处：《中国心脏起搏与心电生理杂志》2004年第5期328-331,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：对 3例阵发性和 2例持续性心房颤动 (简称房颤 )进行左房线性消融。采用Carto标测构建左房三维电解剖图 ,并标识出肺静脉和二尖瓣环 ,在距肺静脉口外 1～ 2cm处进行绕左右肺静脉和左房峡部的环状线性隔离消融 ,后 2例增加一条左房后壁的消融线 ,消融的终点为 :①环状隔离区内的双极电压≤ 0 .1mV ,②跨消融线相邻两点的传导时间延迟 30ms以上。结果 :整个手术时间为 2 2 9± 18min ,X线曝光时间为 2 5± 3min。消融线环绕的左房面积占整个被标测左房面积的 36 %± 3.2 % ,消融线环绕的左房区域内的电压较消融前明显降低 ,绕消融线以外的部分心房组织的电压亦降低。 3例阵发性房颤有 2例在术后 1～ 2天有房颤发作 ,1例持续性房颤于术后 1周转为持续性心房扑动 ,3周时电复律为窦性心律 ,术中和术后随访期内无并发症发生 ,5例在 5 .3± 1.85个月的随访中无有症状的房颤发作。结论 :左房线性电隔离治疗房颤是安全有效的方法。The left atrial linear ablation were performed in three paroxysmal atrial fibrillation (AF) and two patients with persistent AF. Under sinus rhythm or the pacing of di stal coronary sinus, a nonfluoroscopic mapping system was used to generate 3D electroanatomic left atrial(LA) maps and tag the pulmonary veins(PVs) and mi tral annulus, ablative lines were designed near PV ostium 1-2 cm, the another line was between mitral annulus and left inferior PV, in the latter two patients, we added a ablative line on the po sterior wall of left atrium. The following criteria were used define line comtinuity:① Low peak-to-peak bipolar potentials (<0.1 mV) inside the lesion, as determined by local electrogram analysis and voltage maps. ②LAT delay >30 ms between contiguous points lying in the same axial plane on the external and internal sides of the l ine, as assessed by activation maps. The bipolar voltage of atrial tissue encircled by t he ablative lines and partial those outside the ablative line were decreased significantly. The amount of low-voltage encircled area which accounted for 36% ±3.2% of the total LA map surface. Overall procedure duration was 229±18 minutes, and fluoroscopy time was 25±3 minutes. There were recurrence of AF after 1-2 days of the procedure in 2 of 3 patients with paroxysmal AF. One pati ent with persistent AF converted to atrial flutter after 1 week of the procedure, 2 weeks later, it was converted to sinus rhythm by electric cardioversion. All patients were free of symptoms related with atrial fibrillation, and there was no complication s during the 5.3±1.85 months follow-up. Conclusion: The left atrial linear ablat ion for curing atrial fibrillation is safe and effective method.

关 键 词：消融 发作 CARTO系统 心房颤动 并发症 术后 解剖图 指导 结论 区域内 

分 类 号：R541[医药卫生—心血管疾病] R735[医药卫生—内科学]