环肺静脉电隔离治疗持续性和（或）长期持续性房颤的疗效及术后复发的处理  

Clinical Evaluation of Circumferential Pulmonary Vein Isolation in Cases with Chronic Atrial Fibrillation and Measures in Recurrence

作　　者：张吉[1] 惠杰[1] 罗刚[2] 邹操[1] 陈弹[1] 薛枫[1] 宋建平[1] 

机构地区：[1]苏州大学附属第一医院心内科,江苏苏州215006 [2]赣州市人民医院,江西赣州341000

出　　处：《中国血液流变学杂志》2013年第1期46-48,54,共4页Chinese Journal of Hemorheology

摘　　要：目的评价EnSite-NavX系统引导下环肺静脉消融电隔离治疗持续性和（或）永久性心房颤动（房颤）的有效性、安全性、术后早期复发房性心律失常的处理及再消融策略.方法入选2007年2月-2012年6月药物治疗无效或不能耐受的持续性/永久性房颤17例,男性15例,女性2例,平均年龄58.4±8.0（44-68）岁,平均房颤持续时间12.7±16.1月（2周-4年）,平均左心房内径46.0±6.2（37-55）mm.在EnSite-NavX系统引导下环肺静脉消融达到电隔离,部分患者加左房顶部、左房峡部和三尖瓣峡部线消融.结果17例均顺利完成手术.平均手术时间247.4±67.4（110-350）min,平均X线透视时间39.0±12.5（15-65）min.肺静脉隔离率100%.1例术中房颤终止,16例肺静脉隔离后仍为房颤.16例术中电复律,1例术后第4天电复律.6例术后早期发作房颤/房扑,4例长期维持窦性心律;术后晚期5例复发房性心律失常,2例再次消融成功.术后平均随访11.4±8.1（3.5-28）月,14例（82.4%）无超过30s的房性心律失常发作（包括1例服用胺碘酮、2例第二次手术）.单纯肺静脉隔离组（CPVI）11例患者全部手术成功,加线消融组6例患者3例成功.1例急性心包填塞,经心包穿刺引流后痊愈.结论环肺静脉消融电隔离能有效治疗持续性和（或）长期持续性房颤,安全性好.Objective To evaluate the effectiveness and safety of circumferential pulmonary vein（PV） isolation in cases with persistent/permanent atrial fibrillation（AF） and measures in recurrence.Methods Seventeen cases（15 males,mean age 58.4±8.0years） with persistent/permanent AF were enrolled from February 2007 to June 2012.The mean duration of AF was 12.7±16.1months（2 weeks-4 years）.The mean left atrium diameter was 46.0±6.2（37-55）mm.Circumferential PV isolation was performed guided by the EnSite-NavX system,combined with linear ablation of the superior-posterior wall of left atrium,mitral isthmus and tricuspid isthmus partially. Results All 17 cases underwent the procedure successfully,with the mean procedural time 247.4±67.4（110-350） min and the mean fluoroscopic time 39.0±12.5（15-65）min.The pulmonary vein isolation rate was 100%.AF was converted to atrial flutter（AFL） in 1 case.Sinus rhythm was restored by cardioversion in 17 cases.AF/AT was documented in 6 cases in the early of post-ablation,which was restored by cardioversion or controlled by amiodarone,and 2 cases maintained sinus rhythm in long term;AF/AT was documented in 5 cases in the later of post-ablation,and 2 of them were abolished by re-ablation.After a mean of 11.4±8.1（3.5-28）months of follow-up,14 cases（82.4%） were free of AF（1 case with anti-arrhythmic drugs and 2 with re-ablation）.All 11 cases in the CPVI group were free of AF,and 3 of 6 cases were free in the other group.Acute pericardial tamponade was found in 1 case and was cured after proper treatment.Conclusion Circumferential PV isolation was effective and safe for eliminating persistent/permanent AF.

关 键 词：慢性房颤 导管消融术 肺静脉隔离 

分 类 号：R541.75[医药卫生—心血管疾病]