线性消融治疗长程持续性房颤的疗效分析  

Circumferential pulmonary vein electrical isolation combined with left atrial linear ablation guided by unipolar mapping of complex fractionated atrial electrograms in treating long lasting persistent atrial fibrillation

作　　者：徐健[1] 苏浩[1] 孙贤林[1] 朱红军[1] 李镇[1] 朱静[1] 汪贵忠[1] 严激[1] 

机构地区：[1]安徽医科大学附属省立医院,230001

出　　处：《临床心电学杂志》2012年第4期263-266,共4页Journal of Clinical Electrocardiology

摘　　要：目的探讨环肺静脉隔离联合碎裂电位单极标测为基础的线性消融治疗长持续性心房颤动的有效性与安全性。方法共8例长时程持续性房颤患者,男6例,女2例,年龄(57.8±8.2)岁,病程(3.4±2.9)年。消融步骤是先行环肺静脉前庭隔离,标测左房碎裂电位QS型分布区,设计消融路线。消融后如未恢复窦律,行电复律,复律后验证肺静脉电位有无恢复及消融线的完整性。消融终点为双肺静脉电位隔离及消融线双向阻滞。术后所有患者均给予服用可达龙口服0.6g/d连续1周,继之0.4g/d连续1周,以后0.2g/d,共6个月;华法林抗凝6个月,如无复发可停用。术后第1、3、6、12月行动态心电图检查。结果消融术中8例行电复律转复为窦律。8例均实现双侧肺静脉电隔离,消融线完整,随访6-24个月,动态心电图无房速、房扑、房颤复发。结论长时程持续性房颤患者,环肺静脉隔离联合碎裂电位单极标测为基础的线性消融能够破坏更多的维持机制,是治疗长时程持续性房颤的安全、有效的方法。Objective To evaluate the clinical efficacy and safety of circumferential pulmonary vein atrium isolation combined with left atrial linear ablation based on unipolar mapping CFAEs in treating long lasting persistent atrial fibrillation. Methods Eight patients（6 men 2 women mean age 57.8±8.2 years） were studied. The mean AF history of these patients was 3.4 ±2.9 years. Circumferential pulmonary vein atrium isolation was performed in all the patients, then the ablation lines was designed by mapping complex fractionated atrial electrograms of Qs morphology. Electrical cardioversion was performed if sinus rhythm was not restored, then the pulmonary vein potential and bidirectional conduction block was examined. The endpoint of ablation was electrical isolation of pulmonary vein potential and bidirectional block of linear lesions. All patients took oral amiodarone 0.6g/d during the first week post ablation, 0.4g/d for another week and 0.2 g/d in the following 6 months. Dynamic electrocardiograms were examined at 1, 3, 6, 9 and 12 months post ablation. Results The eight patients changed back to sinus rhythm after cardioversion. All patients achieved electrical isolation of pulmonary vein to atrium.Ablation lines were completed. A followup of （6-24） months was conducted. Results showed that there was no recurrence of atrial fibrillation during follow up. Conclusion Circumferential pulmonary vein atrium isolation combined with left atrial linear ablation based on unipolar mapping CFAEs is safe and effective in treating long lasting persistent atrial fibrillation.

关 键 词：长程持续性心房颤动 线性消融术 碎裂电位 

分 类 号：R541.75[医药卫生—心血管疾病]