环肺静脉电隔离术中补点消融部位的统计分析  

Statistical analysis of the gap ablation area during circumferential pulmonary vein isolation

作　　者：陈诤[1] 陈松文[1] 陈岗[1] 孟伟栋[1] 严轶文[1] 张锋[1] 刘少稳[1] 

机构地区：[1]上海交通大学附属第一人民医院心内科,上海200080

出　　处：《中国心脏起搏与心电生理杂志》2013年第4期315-317,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨心房颤动(简称房颤)患者行环肺静脉电隔离(CPVI)术中肺静脉电传导残余及恢复的解剖学分布。方法对484例首次在三维电解剖标测系统指导下接受CPVI治疗的房颤患者,统计在左右肺静脉完成预设消融径线后即刻以及30 min内及30 min之后观察期间补点消融的部位,并比较其差别。结果肺静脉大环消融完成后,687(71.0%)侧肺静脉仍有残余电传导,其补充消融共1 050个部位;其中380(78.5%)例左肺静脉(LPV)共补点581部位,更多分布于LPV前交叉部位;307(63.4%)例右肺静脉(RPV)共补点469部位,更多分布于RPV前、后交叉部位。LPV残余电传导发生率高于RPV(78.5%vs 63.4%,P<0.01)。术中30 min观察期间,152(15.7%)侧肺静脉有电传导恢复,其再次补充消融部位共154个;其中79(16.3%)例LPV补点81个部位,更多位于前交叉部位;73(15.1%)例RPV补点73个部位,更多位于前、后交叉部位。总观察期间,180(18.6%)侧肺静脉有电传导恢复,再次补充消融199个部位;其中87(18.0%)例LPV补点97个部位,更多分布于前交叉部位;93(19.2%)例RPV补点102个部位,更多分布于RPV前、后交叉部位。总观察期间,LPV电传导恢复的发生率与RPV无显著差异(18.0%vs 19.2%,P=0.62)。结论环肺静脉电隔离术中肺静脉电传导残余及恢复的位点多见于左肺静脉前交叉部位及右肺静脉前、后交叉部位。Objective The anatomy distribution of residual and recurrent conductions between left atrium （LA） and pulmonary vein （PV） during circumferential PV isolation （CPVI） was analyzed. Methods A number of 484 patients, who underwent CPVI guided by three dimensional electroanatomic mapping system＇ （CARTO） for the first time, were en- rolled in this study. After the PV isolation, the Lasso was placed within one of the ipsilateral PVs to evaluate the LA-PV conduction for at least 30 min post-isolation. Reinforcement ablation was also performed to isolate the recurrent LA-PV con- duction during the observation period of the procedure. The anatomy distribution of the residual and recurrent LA-PV con- duction was collected and analyzed. Results After the circumferential PV ablation, residual LA-PV conduction was ob- served in 687 （71.0%） ipsilateral PVs for 1050 sites. The incidence of residual LA-PV conduction of the left PV[ （LPV, 380 （78.5%） ] was higher than that of the right PV [ RPV, 307 （63.4%）, P〈0.01 ]. Furthermore, during 30 min post- isolation observation period, the anteromedian was also the most common site for recurrent LPV conduction and the antero- median and posteromedian was also the most common sites for recurrent RPV conduction. During the whole operation time, recurrent LA-PV conduction was observed in 87 （ 18.0% ） LPVs and 93 （ 19.2% , P=0.62） RPVs. The anteromedian was the most commonly location for the recurrent LPV conduction. The recurrent PV conduction was most frequently identi- fied at the anteromedian and posteromedian of RPV. Conclusion The residual and recurrent LA-PV conduction during the operation of circumferential pulmonary vein isolation mostly occurred in the anteromedian of LPV, and in both the an- teromedian and posteromedian of RPV.

关 键 词：心血管病学 心房颤动 环肺静脉电隔离 肺静脉电位 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]