应用带有标测功能的冷冻球囊进行肺静脉电隔离  

Pulmonary vein isolation using cryoballoon catheter with mapping electrode

作　　者：唐闽[1] 李劲宏 方丕华[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外心血管病医院心律失常中心, 100037 [2] 德国心脏中心心脏电生理室

出　　处：《中华心律失常学杂志》2014年第1期31-34,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：基金项目：中国医学科学院北京协和医学院留学回国人员科研启动基金（2011-F16唐闽）

摘　　要：目的 研究应用带有微型环肺静脉标测导管（微环导管）的冷冻球囊完成肺静脉电隔离的可行性.方法 入选2007年12月至2013年3月在德国心脏中心（柏林）接受导管消融的202例阵发性心房颤动（房颤）患者.1次房间隔穿刺后,将冷冻球囊置入左心房.冷冻球囊中央管中放置1根微环导管,作为“导引钢丝”和肺静脉标测导管.结果 电隔离751根肺静脉.其中405根肺静脉（53.9％）在冷冻消融过程中,实时记录到肺静脉电位消失;346根肺静脉（46.1％）在冷冻消融后,回撤微环导管,证实肺静脉电隔离.平均手术时间（131.4±51.7） min,X线曝光时间（23.7±11.3） min.随访33.4（6～63）个月,131例（64.9％）患者无房颤发作.1例患者在隔离右上肺静脉时出现膈神经麻痹,1个月后恢复.结论 使用带有标测功能的冷冻球囊进行肺静脉电隔离是有效、可行的.Objective This study aims to evaluate the feasibility and efficacy of a simplified cryoballoon technique in which a microcircular catheter was introduced into the central lumen of a cryoballoon catheter for the purpose of recording pulmonary vein（PV） potentials during ablation procedures and without interchanging catheters.Methods A total of 202 consecutive patients with paroxysmal atrial fibrillation （AF） were enrolled.A single transseptal puncture was made and a cryoballoon catheter was inserted into the left atrium.A 6pole mapping catheter with a 0.035-inch shaft diameter was introduced into the PV through the central lumen of the cryoballoon catheter.In addition to the function as a recording device,the mapping catheter was also used as a ‘guide-wire＆#39; during the procedure.Results A total of 751 PVs were completely isolated using this novel cryoballoon technique.Isolation was observed in real time in 405 veins（53.9%）during the cryoablation.The remaining 346 veins（46.1%） isolation was confirmed immediately post ablation attempt with the mapping catheter.The mean procedure time was（131.4±51.7） min,and fluoroscopy time was（23.7±11.3） min.At follow-up（33.4 months,range 6-63 months）,131 （64.9%） patients were free from AF.There was one occurrence of phrenic nerve palsyduring ablation of a right superior PV,which fully resolved after one month.Conclusion The use of a cryoballoon catheter equipped with a 6-pole micromapping catheter inserted through its central lumen for the purpose of mapping and ablation during PV isolation procedures is both feasible and effective.

关 键 词：心房颤动 冷冻球囊 消融 肺静脉电位 

分 类 号：R541.7[医药卫生—心血管疾病]