ENSITE-NAVX和双LASSO指导下的左心房线性消融治疗阵发性心房颤动  

Left atrium linear lesion encircling pulmonary veins guided by EnSite-NavX and double-Lasso technique for paroxysmal atrial fibrillation

作　　者：陈明龙[1] 邹建刚[1] 徐东杰[1] 杨兵[1] 陈椿[1] 单其俊[1] 李闻奇[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029

出　　处：《中华心血管病杂志》2005年第11期971-974,共4页Chinese Journal of Cardiology

基　　金：卫生部课题(WKJ2004-2-004);江苏省卫生厅课题资助

摘　　要：目的在EnSite-NavX和双Lasso指导下环肺静脉口外线性消融,使肺静脉电活动与心房电活动分离,介绍这一手术方法治疗阵发性心房颤动(房颤)的初步经验.方法 2004年4月至11月,共收治22例阵发性房颤患者,其中男性19例,女性3例,年龄25～67(48.5±11.4)岁,房颤病史0.5～13.0(4.3±3.3)年.3例有原发性高血压史,余均无器质性心脏病病史.超声心动图检查示左心房直径为31～46(37.5±4.6)mm.所有患者在建立EnSite-NavX左心房几何构型后,于肺静脉开口外0.5～1.0 cm处设置环右侧肺静脉和左侧肺静脉的环状消融线径.盐水灌注导管沿拟定消融线逐点消融,完成右侧消融环线至Lasso电极上肺静脉电位消失;再完成左侧消融环线至肺静脉电位消失.术后服用普罗帕酮450 mg/d、培哚普利4 mg/d,共3个月.结果 22例患者,除1例术中因心包填塞未达消融终点外,余21例均达到消融终点;其中3例于房颤节律时消融,余18例于窦性节律下消融.手术时间5.0～10.0 (6.6±1.3) h,X线时间为30～84(56.1±18.0)min.随访3～11(5.3±2.7)个月,10例患者术后症状消失,Holter示偶见房性早搏.2例经再次手术后未再有房颤发作.3例术后1个月内有阵发性房颤发作,但1个月后未再有发作.2例术后仍有心悸症状,但无房颤发作,Holter示频繁房性早搏,少数组成短阵房性心动过速;3例仍有房颤发作;1例患者房颤发作更趋频繁.术中共2例发生心包填塞.本研究组总成功率为81%.结论 EnSite-NavX和双Lasso指导下的左心房线性消融治疗阵发性房颤具有较高成功率,其长期结果有待于更多病例的积累和更长时间的随访.Objective To evaluate the efficacy of left atrium linear lesion encircling pulmonary veins （PV） guided by EnSite-NavX and double-Lasso technique for paroxysmal atrial fibrillation （PAF）. Methods Twenty-two patients （ male 19, mean age of 48. 5 years ±11.4 years ） with symptomatic PAF were enrolled. After a geometry of the left atrium was reconstructed by EnSite-NavX system, PV ostia were marked on the map based on venography. Two Lasso catheters were placed within the ipsilateral superior and inferior PVs. Irrigated radiofrequency energy was applied at 0. 5 - 1.0 cm of distance from the PV ostia. Continuous linear lesion was done to obtain the disappearance of pulmonary vein potentials. Patients were on propafenone and perindpril for three months after the procedure, Results The endpoint for ablation was reached in 21 patients and 1 patient was not successful because of cardiac tamponade. The mean procedure time was 6. 6 h ± 1.3 h and the mean X-ray exposure time was 56. 1 rain ± 18. 0 rain. After a mean 5.3 months ± 2. 7 months of follow-up, 10 patients were free of symptoms. Two patients had no PAF recurrence after the second procedure. Three patients had clinical recurrence of PAF in the first month. The total success rate in this study was 81% （17/21）. Mortality was 0% and the overall complication rate was about 9% （2/22）. Conclusion Left atrium circumferential linear ablation surrounding PV ostia guided by EnSite-NavX and double-Lasso technique is effective in PAF, but some patients will need more than one procedure in order to achieve a success.

关 键 词：心房颤动 导管消融术 肺静脉 

分 类 号：R541.75[医药卫生—心血管疾病] R541.750.5[医药卫生—内科学]