环肺静脉加辅助径线消融治疗持续性和永久性心房颤动  

Circumferential pulmonary vein with additional linear ablation for persistent and permanent atrial fibrillation

作　　者：刘育[1] 刘少稳[2] 马长生[3] 鲁端[4] 马坚[5] 黄从新[1] 无 

机构地区：[1]武汉大学人民医院心内科,430060 [2]上海复旦大学附属中山医院心内科 [3]北京安贞医院心内科 [4]浙江大学医学院附属邵逸夫医院心内科 [5]北京阜外心血管病医院心律失常诊治中心 [6]代表中华医学会心电生理和起搏分会全国心房颤动工作组

出　　处：《中华医学杂志》2009年第2期96-99,共4页National Medical Journal of China

基　　金：卫生公益性行业科研专项基金（200802157）;湖北省“十一五”重大科技攻关基金（2006AA301A04）;湖北省自然科学基金创新群体基金（2007ABC011）

摘　　要：目的评估环肺静脉加辅助径线消融治疗持续性和永久性心房颤动（房颤）的有效性和安全性，分析房颤消融后复发的危险因素。方法通过多中心临床注册研究的方式收集全国2006年1月至2006年12月期间行环肺静脉加辅助径线消融治疗持续性和永久性房颤的127例病例资料，分析环肺静脉加辅助径线消融治疗持续性和永久性房颤的成功率和复发率，对心脏功能和房性心律失常的影响，以及并发症发生情况。将临床和超声影像学指标作为待选变量，探讨消融后房颤复发的危险因素。结果在平均（9±4）个月随访期间，成功率为68．5％，复发率为31．5％。消融成功的患者术后左心房内径[（41±8）mm vs（43±7）mm]、左心室舒张末期直径[（494-7）mm vs（48±6）mm]和左心室射血分数[（61±8）％vs（624-10）％]较术前无明显改变（均P〉0．05）。消融后房性心动过速和房性早搏有所增加（P〈0．05和P〈0．01）。消融并发症为皮下血肿3例（2．4％）。与复发相关的危险因素有女性（P〈0．05）和左心房增大（P〈0．05）。结论环肺静脉加辅助径线消融治疗持续性和永久性心房颤动安全性好，具有较好的有效性。Objective To investigate the safety and efficacy of circumferential pulmonary vein with additional linear ablation in treatment of persistent and permanent atrial fibrillation （ AF）, and to identify possible predictors of recurrence of AF. Methods The clinical data of 127 patients with persistent and permanent AF who had undergone circumferential pulmonary vein with additional linear ablation from January 2006 to December 2006 in multiple electrophysiological centers were collected, success rate and recurrence rate, cardiac function and atrial arrhythmias after ablation, and complications were analyzed. The relationship between the recurrent AF and clinical and echocardiographic variables was investigated. Results A mean follow-up of 9 ± 4 months showed that the success rate and recurrence rate were 68.5% and 31.5% respectively. After, both The left atrium diameter, left ventricular end diastole diameter , and left ventricular ejection fraction of the patients with successful ablation were （41±8） mm, （49±7） mm , and （61±8）% respectively, all not significantly different from those before ablation [ （43±7） mm, （48±6） mm, and （62± 10）% respectively, all P 〉 0. 05 ]. After ablation the episodes of atrial tachyarrhythmias and atrial premature beat significantly increased （ P 〈 0.05 and P 〈 0. 01 ）. The only complication was ecchymoma that occurred in 3 patients （ 2.4% ）. Female gender and left atrium enlargement were risk factors of recurrent AF （ P 〈 0. 05 and P 〈 0. 05 ）. Conclusion Circumferential pulmonary vein with additional linear ablation is a safe and moderately effective treatment for persistent and permanent atrial fibrillation.

关 键 词：心房颤动 导管消融 辅助径线 

分 类 号：R686[医药卫生—骨科学]