三维标测系统和单环状标测导管指示下环肺静脉线性消融电学隔离肺静脉方法学评价  

Methodology of pulmonary vein isolation with circumferential linear ablation guided by 3 dimensional mapping system and single circular mapping catheter in patients with atrial fibrillation

作　　者：董建增[1] 马长生[1] 刘兴鹏[1] 龙德勇[1] 王京 刘小青[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中华心律失常学杂志》2005年第2期105-109,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家"十五"科技攻关资助项目(2004BA714B04)

摘　　要：目的探讨三维标测系统和单环状标测导管指示下环肺静脉线性消融电学隔离肺静脉的可行性和有效性。方法2004年5月至2004年11月间我院对68例症状明显、发作频繁、抗心律失常药物治疗无效的心房颤动(房颤)患者进行了在Carto(n=56)或EnSite/NavX(n=12)和单环状标测导管指示下的环肺静脉线性消融肺静脉电隔离术。收集操作过程中的相关数据,计算初始肺静脉电学隔离率、最终肺静脉电学隔离率及并发症资料。结果68例患者共计完成136个环形消融线,操作时间平均为(240±65)min,X线曝光时间平均为(37±12)min。用于左心房重建和环肺静脉线性消融的放电时间分别为(20±9)min和(62±24)min。在完成预定环肺静脉消融线后,初始肺静脉电学隔离率为50.7%(69/136),经寻找缝隙补充消融后最终肺静脉电学隔离率为95.6%(130/136)。70.2%(59/84)的缝隙分布于左侧,29.8%(25/84)见于右侧。并发症包括1例心脏压塞和2例锁骨下及左胸部皮下血肿,均经保守治疗康复,无肺静脉狭窄。结论三维标测系统加单环状标测导管指示下环肺静脉线性消融电学隔离肺静脉成功率高、并发症率低,操作时间及X线曝光时间可以接受。Objective To investigate the feasibility and efficacy of pulmonary vein (PV)isolation with circumferential PV linear ablation guided by 3 dimensional mapping system and single circular mapping catheter in patients with atrial fibrillation(AF).Methods From May 2004 to November 2004,circumferential PV linear ablation guided by Carto system or EnSite/NavX system was performed in 68 consecutive highly symptomatic patients (pts) with drug refractory AF.Data associated with procedure was collected,and initial PV isolation rate,cumulative PV isolation rate,and complication rate were statistically analyzed.Results Circumferential PV linear ablation was conducted in 68 pts,up to 136 linear circles were produced around each ipsilateral PVs.Mean procedure time and fluoroscopy time were(240±65)minutes and (37±12)minutes,respectively.Mean duration of left atrium geometry reconstruction and radiofrequency energy delivery was(20±9)minutes and (62±24)minutes,respectively.After ablation at predetermined circular line,50.7%(69/136) of ipsilateral PVs were isolated simultaneously.After additional ablation applied at gaps,95.6%(130/136) of cumulative PV isolation rate was achieved.Seventy point two percent(59/84) of the gaps were distributed in left-sided ablation lines,30.0%(25/84) in right-sided lines.One cardiac tamponade and 2 subclavian hematoma associated with the procedure were observed.No PV stenosis was found.Conclusions Circumferential PV linear ablation guided by 3 dimensional mapping system and single circular mapping catheter could be applied for AF pts with a high PV isolation rate,a lower complication rate,and an acceptable procedure and fluoroscopy time.

关 键 词：电学隔离 线性消融 三维标测 方法学评价 导管 环状 系统 肺静脉电隔离术 2004年 操作时间 曝光时间 抗心律失常 肺静脉消融 肺静脉狭窄 心房颤动 药物治疗 相关数据 操作过程 皮下血肿 心脏压塞 保守治疗 并发症率 左心房 

分 类 号：R541.7[医药卫生—心血管疾病]