慢性房颤导管消融治疗中二尖瓣峡部消融的方法学研究  

Methodology of Ablation at Mitral Isthmus in Catheter Ablation Treatment of Chronic Atrial Fibrillation

作　　者：喻荣辉[1] 马长生[1] 董建增[1] 刘兴鹏[1] 龙德勇[1] 汤日波[1] 苗成龙[1] 陈刚[1] 桑才华[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：《华中科技大学学报（医学版）》2010年第3期342-345,349,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.30770876)

摘　　要：目的研究慢性房颤导管消融治疗中运用倒"U"形态导管标测消融二尖瓣峡部的有效性。方法塑形成倒"U"形态的CARTO盐水标测消融导管紧密贴靠于二尖瓣峡部,窦性心律下起搏冠状静脉窦远端,若CARTO导管心房波近端早于远端,则提示逆钟向阻滞,同理起搏CARTO导管远端,验证顺钟向阻滞。结果 40例慢性房颤患者,运用倒"U"形态导管标测消融二尖瓣峡部,31例患者实现二尖瓣峡部的双向阻滞,与CARTO激动标测结果一致,其余9例患者未实现二尖瓣峡部的双向阻滞。术后随访(12.7±5.2)个月,在实现二尖瓣峡部双向阻滞的患者中7例(22.6%)复发,未实现二尖瓣峡部双向阻滞的患者中4例(44.4%)复发。结论运用倒"U"形态导管标测消融二尖瓣峡部是一种简单、快速、有效的导管操作方法 。Objective To investigate the validity of inverted-＂U＂-form catheter mapping and ablation technique in ablation at mitral isthmus.Methods A CARTO irrigating catheter with inverted-＂U＂-form placement was pressed closely to mitral isthmus.If pacing at the distal of coronary sinus electrode when in sinus rhythm,the proximal atrial wave at CARTO catheter was earlier than the distal atrial wave,which indicated counterclockwise block of mitral annulus;Similarly,if pacing at the distal of CARTO catheter,the proximal atrial wave at coronary sinus electrode was earlier than the distal atrial wave,which indicated clockwise block.Results Forty cases of chronic atrial fibrillation were subjected to inverted-＂U＂-form catheter mapping and ablation technique in ablation at mitral isthmus.Thirty-one cases achieved bi-direction block of mitral isthmus,which were the same as the following activation mapping results,and the remaining 9 cases didn’t achieve bi-direction block of mitral isthmus.In the former group,7 cases recurred,and in the latter group 4 cases recurred.Conclusion Applying inverted-＂U＂-form catheter mapping and ablation technique in ablation at mitral isthmus was an easy,quick and effective catheter manipulation method.

关 键 词：慢性房颤 二尖瓣峡部 导管消融 

分 类 号：R541.75[医药卫生—心血管疾病]