心腔内超声辅助射频精炼消融术治疗心房颤动  

Refined Catheter Ablation of Focal Trigger, Focal Driver and Leading Rotor to Cure Atrial Fibrillation with the Assistance of Intracardiac Echocardiography

作　　者：郭成军[1,2] 胡大一[1,2] 商丽华[1,2] 杨新春[1,2] 张建军[1,2] 吴永全[1,2] 李宜富 秦绪光[1,2] 吴旸[1,2] 许玉韵[1,2] 

机构地区：[1]首都医科大学心血管病研究所 [2]北京红十字朝阳医院心脏中心,北京100020

出　　处：《中国医药导刊》1999年第2期12-17,共6页Chinese Journal of Medicinal Guide

摘　　要：目的:探讨射频精炼消融术治疗心房颤动(房颤)的方法与效果。方法:选择反复、频发、药物疗效欠佳的房颤行心内电生理检查。X光透视、心腔内超声成像、激动顺序与起搏标测、夺获、拖带、药物试验结合,确定参与房颤的局灶触发点、驱动源、主导转子及其部位,局部施以点片或短线消融,观察消融反应,随访治疗效果。结果:27例房颤行电生理检查,12例行射频消融,参与机制7例以局灶触发为主,5例以主导转子为主,4例有局灶驱动源,2例3种机制均参与。选择性消融与房颤发作或维持密切相关的部位,6例用点片消融,4例用短线消融,2例用点片加短线消融。消融中房颤终止2例、局部双向阻滞4例,房颤不再诱发4例,房颤减少1例,房早消失1例,房早减少6例、干咳2例、加速性房性逸搏1例、心动过缓1例。术中6例检出无症状并发症,肺静脉内膜断裂1例、右房与左房内血栓4例、局限性心包积液2例。术后2例房颤复发,用单一药物治疗。随访2周至1.5年,未见严重并发症。结论:针对局灶触发、驱动与主导机制作精炼的点片与短线消融可根治或减少与控制房颤的发作。心脏内超声成像提高消融治疗的精确性,便于术中及时发现无症状的并发症,防止术后的不良后果。Objective: This study focused on the methodology and primary results of refined catheter ablation for atri-al fibrillation (Afib) with the assistance of intracardiac echocardiography (ICE) . Methods and results: Twenty -seven patients with repetitive, refractory Afib undergone cardiac electrophysiologic study. Twelve of them (9 men, 3 women, aged from 42 to 76 years old with mean of 52 ± 10 years) taken radiofrequency catheter abktion. Focal trigger was i-dentified in 7 patients by mapping the earliest activation site during premature atrial beats and initiating beat of Afib. Focal driver was identified in 4 patients by the earliest activation site with fastest local rate during on - going Afib. Leading rotor was identified in 5 patients by mapping and entrainment study during atrial flutter or tachycardia converted from sustained Afib using either oral lower - dose of amiodarone pre - procedure or intravenous low - dose of propafenone during procedure. All three mechanisms were identified in 2 patients. Refined ablation was performed in point/patch lesion in 6, in short - linear lesion in 4, in both in 2 cases under the guidance of ICE. After procedure, 2 cases had recurrence of Afib, others remained in sinus rhythm with frequent premature atrial beats, with ICE asymptomatic complications were identified in six patients during procedure, pulmonary vein dissection and minimal stennosis in 1, atrial thrombus in 4, localized pericardium in 2 cases. No severe complications were found during follow - up of 2 weeks to 1.5 years. Conclusion: Refined ablation of focal trigger, focal driver and leading rotor is effective to cure, reduce or control the attack of Afib. Intracardiac echocardiography provides the precise anatomic information to guide the mapping and ablation for Afib. It is helpful to monitor the asymptomatic complications during procedure in real- time.

关 键 词：心房颤动 消融术 心腔内超声成像 局灶触发点 局灶驱动源 

分 类 号：R541.75[医药卫生—心血管疾病]