心房颤动肺静脉电隔离术后房性早搏的三维标测和消融  

Atrial premature beats following pulmonary vein isolation for paroxysmal atrial fibrillation：3D mapping and catheter ablation

作　　者：王新华[1] 刘旭[1] 施海峰[1] 谭红伟[1] 韩冰[1] 姜伟峰[1] 周立[1] 杨国澍[1] 刘玉岗[1] 张献玲[1] 

机构地区：[1]上海交通大学附属胸科医院心内科,200030

出　　处：《中华心律失常学杂志》2010年第5期388-391,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 探讨心房颤动（房颤）环肺静脉电隔离术后频发房性早搏（房早）的分布特点和评价消融的效果.方法 21例患者（男性13例,女性8例）,平均年龄（51.2±8.7）岁.平均距阵发性房颤环肺静脉隔离术（2.3±1.1）个月.经24 h动态心电图检查,平均房早个数为（12110±375）个.肺静脉起源房早予以再次补点隔离肺静脉,其他部位房早采用三维激动标测和消融.消融术后随访心电图、24 h动态心电图评价消融效果.结果 肺静脉电位恢复2例,均为房早起源部位（左上肺静脉1例,左下肺静脉1例）,补点隔离肺静脉后房早消失.余19例无肺静脉电位恢复,其中起源于左心房右后上壁2例、后下壁4例,左心房顶部4例、左心房左前上壁2例,冠状静脉窦口1例,界嵴中部2例,高右心房间隔2例,高右心房后上壁1例,三尖瓣环6点位置1例.消融后共使18例（85.7%）房早消失.消融术后随访（11.7±4.2）个月,17例（81.0%）无房早复发.结论 阵发性房颤环肺静脉电隔离术后房早分布离散,主要起源于左心房（66.7%）,但多与肺静脉电位无关,其次为起源于右心房.三维标测和消融疗效良好.Objective To explore the distribution of atrial premature beats（ APC）foci following pulmonary vein isolation for atrial fibrillation（AF） and to evaluate the effectiveness of reablation. Methods Twentyone patients（ 13 males,mean age of 51.2 ±8. 7 years）were enrolled after a mean of （2. 3 ± 1.1 ）months following AF ablation. By 24 h Holter monitoring the mean amount of APC was 12110 ± 375. Pulmonary vein（PV） reisolation was applied if APC were from PV,and 3D mapping and ablation was performed if the origin APC foci were unknown. ECG and Holter were used to evaluate the effectiveness of APC ablation. Results PV re-connection as the APC origin was found in 2 cases and was re-isolated by gaps ablation in initial lesion lines. No PV potentials detected in other 19 cases. APC originated from left atrium（LA） in 14 cases,including from upper postero-superior wall in 2 cases, postero-inferior wall in 4 cases, roof area in 4 cases, and left antero-superior wall in 2 cases. APC originated from right atrium （ RA ） in 7 cases, including from coronary sinus ostium in 1 case ,middle crista terminalis in 2 cases, high RA septum in 2 cases, RA posteo-superior wall in 1 case ,and six o＇clock site of tricuspid annulus in 1 case. Catheter ablation eliminated APC in 18 （85.7 % ）cases. At the end of（ 11.7 ± 4. 2 ） months of follow-up, 17 （ 81% ） cases were free of APC recurrence. Conclusion The distribution of APC foci following paroxysmal AF ablation was discrete. APC originated from LA in two thirds of patients, but usually was uncorrelated with PV conduction recovery. Less commonly APC originated from RA. APC following AF ablation could be treated effectively by 3-D mapping and ablation.

关 键 词：心房颤动 肺静脉 导管消融 房性早搏 

分 类 号：R541.7[医药卫生—心血管疾病]