起源于肺静脉的阵发性心房颤动导管射频消融治疗  

Effects of radiofrequency ablation for paroxysmal atrial fibrillation originating from the pulmonary veins

作　　者：吴书林[1] 杨平珍[1] 刘震[1] 李海杰[1] 陈泗林[1] 詹贤章[1] 方咸宏[1] 薛玉梅[1] 

机构地区：[1]广东省心血管病研究所,广州市510100

出　　处：《岭南心血管病杂志》2002年第1期39-42,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的　探讨环状电极 (Lasso电极 )标测指导起源于肺静脉的阵发性心房颤动 (房颤 )导管射频消融治疗的安全性和有效性。方法与结果　 2 0 0 1年 5～ 12月 ,12例药物治疗无效的阵发性房颤患者 ,男 8例 ,女 4例 ,平均年龄 (47 8± 14 9)岁 ,行心内电生理检查和射频消融术。在Lasso电极指导下标测肺静脉 ,以确定诱发房颤的房性早搏起源处。确定房性早搏的消融靶点后 ,在有房性早搏或冠状窦远端起搏或右心耳起搏下寻找优势肺静脉电位 (PVP)放电消融 ,或肺静脉口环状消融。消融终点设定为 :①肺静脉电位振幅明显减低或消失 ;②肺静脉自律性电位与心房电活动无关 ;③诱发房颤的房早消失。结果成功隔离 2 6条肺静脉 ;其中左上肺静脉 12条 ,右上肺静脉 8条 ,左下肺静脉 5条 ,右下肺静脉1条。有 2例仅消融 1条肺静脉 ,均为左上肺静脉 ;8例消融2条肺静脉 ,消融 3条与 4条肺静脉者各 1例。术程 (196 4±6 5 8)min ,X线曝光时间 (5 2 0± 14 4 )min。术后随访 2～ 8个月 ,有 1例频发房早发生 ,经口服胺碘酮后房早消失 ;4例有房颤短阵发作 ,其中 3例接受口服药物 (2例服用胺碘酮 ,1例服用索他洛尔 ) ,1例植入有抗房颤程序的DDDR起搏器 ,能够有效抑制房颤发作。术中选择性肺静脉造影发现 6例有轻度肺静脉狭窄 ,其?Objective To investigate the feasibility and effectiveness of electrophysiologic mapping of pulmonary veins (PVs) with a circumferential 10-electrode catheter and radiofrequency catheter ablation (RFCA) for patients with paroxysmal atrial fibrillation. Methods and Results During May to December 2001, 12 patients [male 8, female 4, mean age (47 8±14 9) years] with paroxysmal atrial fibrillation refractory to antiarrhythmic drugs were included in this group. A circumferential 10-electrode catheter was used to determine the origin of atrial premature contractions. When the ablative target PV was found, PV's ostial ablation was performed at the segments showing earliest activation of pulmonary vein potentials (PVPs). The end point was designed: ① elimination of PVP; ② PVP dissociation from atrial waves; ③ atrial ectopic beats disappear. A total of 26 pulmonary veins were ablated, including 12 LSPVs, 8 RSPVs, 5 LIPVs and 1 RIPV. 1 pulmonary vein (LSPV)in 2 patients was ablated, 2 pulmonary veins in 8 patients were ablated, 3 pulmonary veins were ablated in 1 patient and 4 pulmonary veins were ablated in 1 patient. Procedure duration and fluoroscopy time respectively were (196 4±65 8)min and (52 0±14 4)min. During the follow-up 2～8 months, 1 case with atrial premature recurred and was controlled with amiodarone, 4 cases with paroxysmal atrial fibrillation recurred, 3 of them were treated with amiodarone (2 cases) or sotalol (1 case) and the another case was implantled with DDDR pacemaker (with programmer of anti-atrial fibrillation). Mild stenosis of pulmonary vein occurred in 6 cases, PV's diameter in 1 case reduced 53%, but they were asymptomatic during the follow-up period. 1 case had pneumothrax complication and disappeared with treatment.Conclusion This study suggests that circular or short-line ablation at the ostium of PV under the guide of circular catheter may have higher success rate and splendid future .

关 键 词：阵发性心房颤动 导管消融 射频电流 肺静脉起源 治疗方法 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]