心房颤动微创肺静脉隔离术后患者心律失常复发的电生理特性研究  

Study of electrophysiological properties of recurrent atrial arrhythmia after minimally invasive pulmonary vein isolation for atrial fibrillation

作　　者：曾亚平[1] 朱小玲[1] 崔永强[2] 李岩[2] 刘兴鹏[3] 许春雷[2] 孟旭[2] 

机构地区：[1]首都医科大学附属北京安贞医院急诊综合病房,100029 [2]首都医科大学附属北京安贞医院心外科九病房,100029 [3]首都医科大学附属北京安贞医院心内科二病房,100029

出　　处：《中国医药》2013年第1期1-3,共3页China Medicine

基　　金：首都医学发展基金（2005-2001）

摘　　要：目的对心房颤动微创肺静脉隔离术后患者心律失常复发的电生理特性进行研究。方法入选8例接受微创肺静脉隔离术后复发心律失常的孤立性心房颤动患者，其中阵发性心房颤动3例，持续性心房颤动5例。患者均在Carto标测系统指导下进行导管消融，观察微创术后心律失常复发患者的电生理特性。结果8例复发心律失常患者中，心房颤动4例，房性心动过速1例，心房扑动3例。Carto三维标测提示3例心房颤动患者的“裂隙”存在于肺静脉隔离线的顶端或底端，第4例复发心房颤动的患者“裂隙”在肺静脉隔离线上。1例房性心动过速的发生源于残余左心耳基底部的微折返。3例心房扑动患者中，2例围绕二尖瓣瓣环，1例在左心房顶部。导管消融术后随访3～11个月，8例患者均为窦性心率，且无需服用任何抗心律失常药物。结论肺静脉隔离线的两端是心房颤动微创肺静脉隔离术后复发常见的位置，心房扑动是微创肺静脉隔离术后常见的心律失常。Objective To observe the electrophysiological properties of patients with recurrent atrial ar- rhythmia after minimally invasive puhnonary vein isolation for atrial fibrillation. Methods Eight patients with re- current atrial arrhythmia after minimally invasive pulmonary vein isolation were recruited（ 3 cases with paroxysmal at- rial fibrillation and 5 eases with persistent atrial fibrillation）. Catheter ablation guided by Carto mapping was per- formed and the characteristics of eleetrophysiology were observed. Results Recurrent atrial fibrillation occurred in 4 patients; atrial taehycardia occulted in 1 patient and atrial flutter was present in 3 patients. Carto mapping re- vealed that in 3 atrial fibrillation patients, lesion gaps were present at the roof and the bottom of pulmonary vein. The fourth recurrent atrial fibrillation was found to have a gap in pulmonary vein isolation ring. One patient with atri- al tachycardia was found to have microreentry around the base of the left atrial appendage. In 3 patients with atrial flutter, ectopic focus was found to be localized around the mitral valve annulus in 2 patients and around the left atrial roof in one patient. All 8 patients underwent ablation successfully. At the latest foflow-up, all patients were free of arrhythmias and independent of antiarrbythmic drugs. Conclusions Pulmonary vein conduction at the roof and the bottom of the pulmonary vein after pulmonary vein isolation is the dominant factor responsible for recurrent atrial taehyarrhythmia. Left atrial-related flutter is a common form of arrhythmia.

关 键 词：心房颤动 微创外科 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]