肺静脉电隔离对环肺静脉线性消融术效果的影响  

Necessity of pulmonary vein isolation as an end point for circumferential pulmonary vein ablation in patient with paroxysmal atrial fibrillation

作　　者：张劲林 徐亚伟 徐剑刚 周可 于学靖 

机构地区：[1]上海市第10人民医院心内科

出　　处：《临床心血管病杂志》2007年第7期516-518,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨肺静脉完全隔离与否对环肺静脉线性消融术治疗阵发性心房颤动(Af)效果的影响。方法:63例阵发性Af患者随机分为隔离肺静脉组(30例)和不隔离肺静脉组(33例)。所有患者均在三维电解剖系统指导下完成环左右肺静脉线性消融。在术前和术后均放置10极环状导管(Lasso)以标测各肺静脉电位情况,对隔离肺静脉组,如环肺静脉消融完成后仍残存肺静脉电位则补充进行节段性肺静脉隔离,而对不隔离肺静脉组环肺静脉消融完成后不作进一步处理。结果:环肺静脉消融完成后,不隔离肺静脉组33例患者中30例(90.9%)未达完全肺静脉隔离。隔离肺静脉组30例患者中26例(86.7%)未达完全肺静脉隔离,在行补充性节段消融后,隔离肺静脉组完全肺静脉电隔离率达96.7%(29/30)。平均随访(11±3)个月后,不隔离肺静脉组81.8%(27/33)的患者和隔离肺静脉组83.3%(25/30)的患者停用抗心律失常药物后无Af发作,2组间差异无统计学意义。结论:环肺静脉线性消融术用于治疗阵发性Af时,术中完全的肺静脉电隔离对于提高长期疗效并非必需。Objective： To investigate whether complete isolation of pulmonary vein （PV） is necessary to circumferential pulmonary vein ablation （CPVA） for paroxysmal atrial fibrillation（PAf）. Method：There were sixty-three patients with paroxysmal Af individed into PV-isolation group （n=30） and PV-nonisolation group（n=33）. CPVA to encircle the left- and right-sided PVs, was performed under the guidance of an electroanatomic navigation system in all patients. The PVs were mapped with a decapolar ring catheter（Lasso）before and after CPVA. If PV isolation was incomplete, additional segmental PV isolation was performed in the PV-isolation group while no attempts were made in the PV-nonisolation group. Result： After CPVA, there was incomplete electrical isolation of one or more PVs in 30 （90.9%） of the 33 patients in the PV-nonisolation group and in 26（86.7%） of the 30 patients in the PV-isolation group, after the additional segmental PV ablation. The rate of complete isolation of PV reached 96.7% （29/30） in the PV-isolation group. At （11 ± 3） months of follow-up, 81.8% （27/33） of the patients in the PV -non isolation group and 83.3% （25/30） of the patients in the PV-isolation group were free from recurrent Af without antiarrhythmic drug therapy （P〉0. 05）. Conclusion： Complete electrical isolation of the PVs is not necessary for a successful outcome of CPVA for PAf.

关 键 词：心房颤动 肺静脉 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]