持续性房颤消融术后早期复发:电复律或二次消融  

Early recurrence after persistent atrial fibrillation ablation: reablation or cardioversion

作　　者：刘玉岗[1] 刘旭[1] 谭红伟[1] 姜伟峰[1] 王远龙[1] 李峥[1] 周立[1] 

机构地区：[1]上海交通大学附属上海市胸科医院心内科,200030

出　　处：《中国介入心脏病学杂志》2013年第1期25-28,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的对持续性心房颤动导管消融术后1个月内复发快速房性心律失常患者,比较早期直流电复律治疗与早期消融治疗的临床效果,为临床决策提供证据,并对持续性房颤早期复发早期消融电生理特点进行分析。方法回顾性分析2010年6月至2011年6月121例首次消融术后1个月内复发房性心动过速的持续性房颤患者,其中早期电复律69例,早期二次消融52例,平均随访(11±5)个月,分析两组的临床效果及手术组二次手术电生理特点。结果 69例早期复律患者平均随访(11±5)个月,14例维持窦性心律。52例手术患者平均随访(10±4)个月,24例维持窦性心律,早期手术组成功率较早期复律组高(46.2%比20.3%,P=0.002)。Logistic回归分析发现,左心房大小及治疗手段是房颤二次复发的独立影响因素。电生理检查发现,52例早期手术患者中,33例(63%)有肺静脉电位恢复。左上肺静脉电位恢复最多,为16支。其余肺静脉电位恢复情况分别为:左下肺静脉14支;右上肺静脉12支;右下肺静脉10支。结论持续性房颤早期复发进行早期二次消融成功率较早期电复律高。肺静脉电位恢复是持续性房颤早期复发的常见现象。Objective In order to provide proof for clinical strategy, we compared the clinical effectiveness of early secondary procedure and early direct cardioversion （DC） for the treatment of early recurrence of atrial tachyarrhythmias （ERAT） following primary ablation for persistent atrial fibrillation （PEAF） in less than 1 month. Methods Analysis of 121 ERAT between June 2010 and June 2011 after primary ablation for the treatment of PEAF was made. There are 69 cases in early cardioversion group in contrast to 52 cases in early secondary procedure group. After a mean follow up of （ 11 ＋- 5） months, we analyzed the clinical statistics and the electrophysiological characteristics of secondary procedure. Results After a mean follow up of 11 ±5 months, 14 were free from AF or AT in DC group. The early secondary procedure group have a higher success rate （46. 2% vs. 20. 3%, P = 0. 002）than early cardioversion group which achieve 24 SR after a mean follow up of （10 ±4） months. Logistic regression analysis revealed that left atrial diameter and therapy were independent factors of secondary recurrence. We found that 33 （63%） cases have PV potentials recovery among the 52 early reablation cases. LSPV have the most PV- reconnections （16） after electrophysiological examination for secondary procedure group. LIPV, RSPV and RIPV had 14, 12 and 10 PV-reconnections respectively. Conclusions Early secondary procedure group have a higher success rate than early cardioversion group for the treatment of ERAT. PV recovery is a common phenomenon of ERAT after first ablation for PEAF.

关 键 词：心房颤动 导管消融术 复发 电抗休克 

分 类 号：R541.75[医药卫生—心血管疾病]