阵发性心房颤动的三维电解剖标测指导左心房线性消融治疗  

Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system

作　　者：张代富[1] 李莹[1] 祁炜罡[1] 梁波[1] 庄少伟[1] 王娟[1] 俞莉[1] 包丽娟[1] 

机构地区：[1]同济大学附属东方医院心内科,上海市200120

出　　处：《中国介入心脏病学杂志》2005年第4期219-221,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨三维电解剖标测指导左心房线性消融治疗阵发性心房颤动(房颤)的有效性和安全性。方法对29例入选的阵发性房颤患者使用Carto系统建立左心房三维电解剖图,结合肺静脉造影确定肺静脉开口,围绕左、右上、下肺静脉口完成环肺静脉线性消融。预设温度43℃,最大功率30W,每点消融时间大于20s。局部电位振幅降低50%以上再移动靶点,逐点完成预定消融线。结果本组患者平均操作时间180±18min,透视时间80±20min。平均放电次数120±15次。术后随访6个月。24例无房颤再发;3例在术后3个月内再发房颤,但次数较前明显减少,6个月后无房颤再发;1例偶有房颤发作;1例复发。所有患者均无肺静脉狭窄发生。结论三维电解剖标测指导左心房线性消融治疗阵发性房颤,在成功率及安全性上具有明显的优势。Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by thre-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequeney （RF） energy was delivercd to create continuous linear lesions encircling the pulmonary veins. It was delivered with a target temperature of 43℃, a maximal power limit of 30W and applied for ≥20 seconds until the maximal local electrogram amplitude decreased by ≥ 50%. The ablation was completed by finishing the circular line. Results The mean procedure duration was 180 ± 18 minutes, with mean fluoroscopy time of 80 ± 20 minutes. The average number of RF pulses was 120 ± 15. After a follow-up of 6.0 months, 24 patients maintained sinus rhythm. 3 patients suffered from less frequent paroxysmal atrial fibrillation during the first 3.0 months after the ablation and remained Af free after 6 months. 1 patient had atrial fibrillation episodes and 1 patient had atrial fibrillation attacks unchanged. No pulraonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective.

关 键 词：心房颤动 电生理学技术 心脏 导管消融术 阵发性心房颤动 电解剖标测 消融治疗 线性消融 左心房 三维 肺静脉造影 

分 类 号：R541.75[医药卫生—心血管疾病] R725.417[医药卫生—内科学]