阵发性心房颤动非肺静脉触发灶的临床特征及长期随访  

Clinical characteristics and long-term outcome of non-pulmonary vein foci ablation in patients with paroxysmal atrial fibrillation

作　　者：陈红武[1] 陈明龙[1] 杨兵[1] 居维竹[1] 张凤祥[1] 顾凯[1] 郦明芳[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029

出　　处：《中华心血管病杂志》2013年第11期922-926,共5页Chinese Journal of Cardiology

基　　金：“南京医科大学第一附属医院创新团队工程”和“江苏高校优势学科建设工程资助项目”

摘　　要：目的 回顾性分析阵发性心房颤动（房颤）非肺静脉触发灶的临床特征及消融的长期随访结果.方法 86例患者入选本研究,男性48例.年龄27 ～73（52.3±10.2）岁,阵发性房颤的病史为（64.4±58.1）月.26例患者有原发性高血压,3例合并冠状动脉粥样硬化性心脏病,1例术前发生脑栓塞.入选患者的左心房直径（36.3 ±4.5）mm,左心室射血分数（63.2±5.2）％.在三维标测系统指导下行肺静脉前庭隔离术达到肺静脉-左房电学隔离;术后常规程序刺激诱发,若合并室上性心律失常或者非肺静脉触发灶,同时消融.结果 所有患者术中均记录到触发灶触发房颤,肺静脉触发59例（组Ⅰ）,非肺静脉触发灶27例（组Ⅱ）,两组间的临床资料差异无统计学意义.首次消融过程中明确12例非肺静脉触发灶,1例位于左心房顶部,11例起源于上腔静脉.平均随访（37.1±10.4）月,首次消融术后,组Ⅰ中20.3％患者复发房颤,与组Ⅱ相比,复发率明显偏低,差异具有统计学意义（组Ⅱ55.5％,P=0.001）.两组患者平均消融次数亦存在明显的差异[组Ⅰ（1.1±0.4）次比组Ⅱ（1.7±0.8）次;P ＜0.001].组Ⅱ中,二次消融的15例患者,11例左侧肺静脉传导恢复,8例右侧肺静脉传导恢复,再次隔离后,共诱导出15处房颤触发灶,2例为肺静脉,13例位于肺静脉之外,11例为上腔静脉,2例起源于冠状静脉窦.二次术后仍有3例复发,其中2例3次手术,触发灶分别位于左房间隔与冠状静脉窦,1例患者4次手术,触发灶位于左心房后壁.结论 非肺静脉触发灶可以发生于任何年龄段,其常见部位为上腔静脉,是肺静脉前庭隔离后复发的主要原因之一.Objective To evaluate the clinical characteristics and long-term results of non- pulmonary veins （PV） trigger ablation in patients with paroxysmal atrial fibrillation （AF）. Methods Eighty-six patients [48 men, mean age （52. 3±10. 2） years] were included in the study. Circumferential pulmonary vein antrum isolation guided by a 3-D mapping system was performed. Aggressive high right atrium programmed stimulation and burst pacing were made before and after isoproterenol infusion. Additional ablation was performed if other trigger foci were found or other sustained taehycardias could be induced. Results PV triggers were observed in 59 patients （ group I ）, and non-PV triggers were observed in 27 patients （group I1 ）, 12 non-PV triggers were identified during the first procedure. Among them, one was located in the roof of left atrium, 11 were originated from superior vena cava. After a mean follow-up of [37. 1 ± 10.4 （range 15-60） ] months, the AF recurrence rate was significantly higher in the Group 1I than in the Group I （ 55.5% vs. 20. 3% , P = 0. 001 ）. The number of performed ablation was also significantly in group II than in group [ higher difference （ 1.7 ± 0. 8 vs. 1.1 ± 0.4, P 〈 0. 001 ）. In the group 11 , 15/15（ 100% ） patients had a repeated ablation procedure for AF recurrence, and 15 patients had new non-PV loci after isoproterenol infusion which were originated from the superior vena cava （ n = 11 ） and coronary sinus （n = 2）, respectively. After the second ablation procedure, AF recurrence was observed in three patients, two patients accepted third procedure, the non-PV triggers were located in left atrial septumand coronary sinus, and one patient accepted fourth procedure, the non-PV loci was located in left posterior wall. Conclusions Non-PV loci may occur at any age and the main area is located in the super vena cava, Non-PV serves as a major cause of AF recurrence after successful PVAI.

关 键 词：心房颤动 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]