电解剖系统引导下环肺静脉线性消融隔离肺静脉治疗心房颤动  

Linear ablation and circumferential isolation of the pulmonary vein guided by electroanatomic mapping system in patients with atrial fibrillation

作　　者：李毅刚[1] 欧阳非凡 陆尚彪[1] 赵美华[1] 王群山[1] 陈书艳[1] 

机构地区：[1]上海第二医科大学附属新华医院心内科 [2]Allgem-eines Krankenhaus St.Georg,Hamburg,Germany

出　　处：《中华心律失常学杂志》2005年第4期277-282,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的采用双Lasso导管标测技术行环肺静脉及其周围组织隔离预防心房颤动复发.方法 13例心房颤动(房颤)患者,男性8例,女性5例,平均年龄为(56±8)岁,行电生理检查和射频导管消融.其中,8例为频发的阵发性房颤(1～20年),5例为持续性房颤(1～4年).窦性心律下起搏远端冠状静脉窦或房颤发生时,利用电解剖系统进行左心房重建.然后,将两根Lasso多极导管同时置于右(左)上、下肺静脉之内.在距肺静脉口1 cm左右处行环肺静脉及其周围组织电隔离.消融终点为左心房-肺静脉/周围组织完全性阻滞,表现为放电时肺静脉电位消失.结果 7例阵发性房颤患者在窦性心律下电隔离成功,5例持续性房颤和1例阵发性房颤患者在窦性心律和房颤发生时电隔离成功.3例患者放电时房颤终止:左肺静脉隔离时房颤终止1例,右肺静脉隔离时房颤终止1例,左肺静脉隔离完成后54 s自行终止1例.其余3例需体外电转复.消融术时间为(256±56) min,X线曝光时间为(39±11) min.无并发症发生.在术后平均随访(104±50) d,只有1例患者在第71 d时出现不典型心房扑动,自行终止.其余12例患者均无房性快速性心律失常复发.结论有明确心电学隔离指标的环肺静脉及其周围组织电隔离是一种安全有效的方法.肺静脉既可为房颤的诱发机制,亦有可能参与房颤的维持机制.Objective The aim of this study is to use two Lasso catheter placed in ipsilateral two pulmonary veins to demonstrate the clear isolation of the pulmonary vein （PV） and the para-ostium of PV. Methods Thirteen patients [ males in 8, females in 5, （56 ± 8 ） years ] with atrial fibrillation （AF） were referred for elctrophysiological study and radiofrequency catheter ablation. Among them, eight patients had frequent paroxysmal AF（1 -20 years） and 5 patients had persistent AF（ 1 -4 yeras）. After reconstruction of the left atrium using Carto system during pacing at distal end of coronary sinus, two Lasso-catheters were located in right superior and inferior PVs, simultaneously. Then, circumferential ablation around two right PVs was performed at a distance of 1 cm away from the ostium of PVs. The endpeint was complete conduction block between left atrium and PVs and the para-ostium of PV as indicated by loss of PV potentials during energy delivery. After completion of the right PV isolation, the same approach for isolation of the left PV and the para-ostium of PV was performed. Results Successful isolation of PVs during sinus rhythm in 7 patients with paroxysmal AF, and during AF and sinus rhythm in 5 patients with persistent AF and 1 patients with paroxysmal AF. AF was terminated during energy delivery in 3 patients. External cardioversion was needed in the three re-maining patients. The procedure time was （256 ±56） minutes, with the X-ray exposure time （39 ± 11 ） minutes. No complication occurred during the procedure. After （ 104 ± 50） days of follow-up in the out-patient clinic,atypical atrial flutter occurred in 1 patients, others were free of AF. Conclusion The present approach with evidence-based isolation of the PV and the para-ostium of the PV is effective and safe. Large-scale clinical trial with long-term follow-up is needed to document the efficacy of the this approach.

关 键 词：电解剖系统 环肺静脉线性消融 隔离方法 肺静脉 心房颤动 双Lasso导管标测技术 

分 类 号：R541.7[医药卫生—心血管疾病]