三维标测指导下心房颤动环肺静脉线性消融的效果评价  

Safety and efficacy of circumferential pulmonary vein linear ablation guided by 3-D mapping system in patients with atrial fibrillation

作　　者：马长生[1] 董建增[1] 汤日波[1] 刘兴鹏[1] 刘晓惠[1] 方冬平[1] 喻荣辉[1] 龙德勇[1] 胡福莉[1] 卢春山[1] 郝蓬[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：《中国实用内科杂志：临床前沿版》2006年第8期1242-1244,共3页

基　　金：国家"十五"科技攻关项目(2004BA714B04)

摘　　要：目的探讨三维标测系统指导下行心房颤动(房颤)环肺静脉线性消融的安全性和有效性。方法2003年4月至2006年3月对首都医科大学附属北京安贞医院收治的410例房颤患者进行三维标测系统(CARTO系统或EnSiteNavXTM系统)指导下的环肺静脉线性消融,消融的主要终点为肺静脉电学隔离。随访成功的定义为经3个月的洗脱期无症状性快速性房性心律失常发生。结果394例实现肺静脉电隔离(96%),平均随访(12.4±6.8)个月,阵发性房颤单次消融成功率为77.3%(221/286),持续性、永久性单次房颤消融成功率69.4%(86/124),后者成功率显著低于前者(P=0.006)。103例复发患者中41例接受再次消融,再次消融成功率为75.6%(31/41)。严重并发症包括心脏压塞4例(0.97%),心包穿刺引流后痊愈;脑卒中3例(0.73%),治疗后无肢体运动障碍,日常生活无影响;无死亡病例。结论三维标测指导下心房颤动环肺静脉线性消融是安全、有效的。Objective To investigate the safety and efficacy of circumferential pulmonary vein linear ablation guided by 3 - D mapping system in patients with atrial fibrillation. Methods From April 2003 to March 2006, 410 consecutive patients with atrial fibrillation underwent circumferential pulmonary vein linear ablation guided by 3 - D mapping system （CARTO system or EnSite NavXTM system）. Success was defined as symptomatic atrial tachyarrhythmia free after 3 months washout period. Results 96%of the 410 patients attained the ablation endpoint. After a mean of （12.4 ±6. 8） months＇ follow - up, clinical success achieved in 77.3% of the patients with paroxysmal atrial fibrillation and 69.4% of the patients with persistent/permanent atrial fibrillation after first - time ablation procedure. The successs rate of the persistent/permanent atrial fibrillation was significantly lower than that of paroxysmal atrial fibrillation. Forty - one of the 103 patients with recurrent atrial fibrillation underwent ablation again. Thirty - one of the 41 patients （ 75.6% ） were atrial tachyarrhythmia free during the follow - up. Severe complications included 4 cases of pericardial tamponade （0. 97% ） and 3 cases of stroke （0. 73% ）. Pericardial tamponades were relieved by pericardiocentesis. The patients with stroke recovered well without any lingering effects. There was no death case. Conclusion Circumferential pulmonary vein linear ablation guided by 3 - D mapping system is an effective therapy for atrial fibrillation patients with an acceptable safety.

关 键 词：心房颤动 导管消融 

分 类 号：R5[医药卫生—内科学]