心内膜标测指导下射频消融右房治疗心房颤动的实验研究  

The experimental study of right atrial radiofrequency catheter ablation guided by activation mapping to treat atrial fibrillation

作　　者：黄从新[1] 江洪[1] 郭伟[1] 王腾[1] 唐其柱[1] 彭善友[1] 柒曙辉[1] 王小红[1] 施冰[1] 陈芳[1] 王晋明[1] 李庚山[1] 

机构地区：[1]湖北医科大学附属第一医院,430060

出　　处：《中华心律失常学杂志》1998年第4期277-280,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：卫生部优秀科技人才专项科研基金资助项目(批准号 970088)

摘　　要：目的探讨优先消融心房无序电活动区域治疗某些类型心房颤动(房颤)的可行性。方法实验犬17只,消融组12只,假性消融组5只。房颤持续过程中行激动标测,发现如下激动特征之一的部位视作优先消融靶区(简称优先区):①电激动无序性特征最为显著的部位;②平均 FF 间期(AFI_(100))最短的部位;③最早出现 F 波(可重复3次以上)且超前其它导联20 ms 以上的部位。消融终点为用术前相同诱发方法不能诱发房颤或房颤持续时间不超过1 min。结果标测发现消融组12只犬有10只存在优先区,优先区相对局限的7只犬实施单一线径消融(单线组);优先区较为广泛的3只犬、未能标测到优先区的2只犬以及单线组未能达到消融终点的2只犬实施多线消融(多线组)。具有优先区的10只犬中8只(80%)术后即刻达到消融终点,单、多线组各4只(4/7 vs 4/7)。未标测到优先区的2只犬均未达消融终点。达到消融终点的4只犬中,3只于术后14天及处死前均未诱发出持续性房颤。假性消融对房颤的发生和持续无明显影响。结论 (1)心内膜标测指导下优先消融心房无序电活动区有望在不降低成功率的同时减少心房肌损伤;(2)右房 RFCA 可能是根治某些类型房颤的有效方法之一。Objective To investigate an endoeardial application of right atrial radiofrequeney catheter ablation(RFCA)guided by activation mapping to prevent induction of experimental atrial fibrilla- tion(AF).Methods Seventeen dogs with experimental AF induced by intravenous infusion of metha- choline and atrial burst stimulation were studied.A mapping site was regarded as a preferential target for R FCA,which had one of the characteristics as follows:(1)the most significant disorganized feature;(2)the shortest mean atrial cycle length(AFI_(100));(3)the earliest F wave was at the same mapping site during 3 episodes of AF.According to endocardial mapping results,RFCA was applied in 12 dogs.The outcome of the procedure was considered a RFCA endpoint when AF could not be induced or duration of AF was less than l rain.Results Single linear lesion led to RFCA endpoint in 4(57.1%)of the 7 dogs.Two of the oth- er 3 dogs entered the multiple lines group together with 3 dogs with an extensive preferential target area and 2 dogs without a preferential target area.RFCA endpoint was achieved in 4(57.1%)of these 7 dogs. The long-term effectiveness of RFCA was assessed 82±16 days after RFCA,and no sustained AF could be induced in 3 of 4 dogs with RFCA endpoint.After same RFCA in 5 clogs,both of the inducible rate(73.3% vs 66.7%,P>0.05)and duration(386.2±56.2 s vs 371.9±62.7 s,P>0.05)of AF had no significant change.Conclusions ①The preferential area found by endocardial mapping during AF may be treated as a target ot RFCA.②For some kind of AF,right atrial RFCA may be an effective and safe technique.

关 键 词：消融终点 标测 治疗 心房颤动 心内膜 假性 部位 射频消融 电活动 诱发 

分 类 号：R541[医药卫生—心血管疾病] R654.2[医药卫生—内科学]