单纯环肺静脉前庭隔离术治疗持续性心房颤动：单中心三年随访结果  

Catheter radiofrequency ablation with circumferential pulmonary vein antrum for treatment of patients with persistent atrial fibrillation： one center 3 years follow-up

作　　者：刘兴鹏[1] 马长生[1] 董建增[1] 田颖[1] 龙德勇[1] 喻荣辉[1] 汤日波[1] 刘小慧[1] 

机构地区：[1]首都医科大学附属北京安贞医院房颤中心,100029

出　　处：《中华心律失常学杂志》2009年第3期185-188,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的报道持续性心房颤动（房颤）单纯环肺静脉前庭隔离术（CPVAI）的单中心远期（3年）随访结果，并探讨持续房颤病程和消融术中心律转归与消融预后的关系。方法连续86例接受CPVAI治疗的持续性房颤患者，男性65例，女性21例，平均年龄（56±12）岁。根据持续性房颤的病程是否超过1年，将其分为短病程（≤1年）组（n=47）和长病程（〉1年）组（n=39）。结果随访时间为25—50（36±8）个月。单次消融后平均随访3年时的成功率为30．2％（26／86）。9例（10．5％）出现晚期复发（发生于随访1年之后）。短病程组单次消融后的3年随访成功率显著高于长病程组（42．5％对15．4％，P〈0．01）。29例（33．7％）CPVAI术中房颤经消融中止（包括转为房性心动过速）患者的3年随访单次消融成功率（48．3％）显著高于房颤未被中止者（21．1％，P〈0．01）。本组共24例复发患者（27．9％）接受了≥2次CPVAI治疗，3年随访的总成功率为41．9％（36／86）。结论单纯CPVAI治疗持续性房颤的临床远期效果仍远不理想，且随访1年之后的远期复发并不少见；持续房颤病程〈1年和CPVAI术中房颤经消融中止者的临床预后相对较好。Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation （PerAF） and discuss the impact of PerAF duration and the termination on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation （CPVAI） only were included in this study. Based on PerAF duration, patients were divided into two groups ： short term （ ≤1 year, n = 47） and long term （ 〉 1 year, n = 39）. Results The mean foUow-up period was 25 - 50 （36 ± 8 ） months. During the follow-up period, the success rate after single procedure was 30. 2% （26/86）. Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients （ 10. 5% ）. The long-term success rate in the short term group was significantly higher than that in long term group （42. 5% vs 15.4% ,P 〈0. 01 ）. During the first procedure, atrial fi- brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients （ 33.7% ）. Compared with the another 57 patients, the long-term outcome of these patients was much better （48.3% vs 21.1% ,P 〈 0. 01 ）. Redo procedures were performed in 24 patients （27.9%）, which increased the total success rate at 3 years follow-up to 41.9% （36/86）. Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVAI treatment.

关 键 词：心房颤动 肺静脉 导管消融 

分 类 号：R541.75[医药卫生—心血管疾病] R749.3[医药卫生—内科学]