阵发性心房颤动消融终点时诱发试验不同阴性结果预后差异  

A retrospective study of prognosis among different negative induction test results in groups in patients with paroxysmal atrial fibrillation underwent circumferential pulmonary vein isolation

作　　者：黄强[1,2] 刘少稳[1] 杨承健[2] 

机构地区：[1]上海市第一人民医院心内科,上海200080 [2]无锡市第二人民医院心内科,江苏无锡214002

出　　处：《南京医科大学学报（自然科学版）》2016年第7期821-825,867,共6页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:探讨阵发性房颤患者环肺静脉电隔离术消融终点时诱发试验不同阴性结果预后差异。方法:回顾性选取133例因阵发性房颤接受消融且以诱发试验阴性(不能诱发或可诱发持续不超过3 min短阵房性心律失常)为消融终点、并成功达到终点的患者。所有患者均在环肺静脉电隔离后(定义为完成预设消融径线并达到肺静脉-左房双向电传导阻滞)行诱发试验,分别于冠状窦口及远端行猝发刺激(10 m A,脉宽2 ms),从300 ms递减直至心房失去1∶1夺获,如诱发持续>3 min短阵房性心律失常则进一步标测并进行局灶或折返环峡部消融。按照消融终点时诱发试验不同阴性结果分为不能诱发组(A组)和可诱发短阵(持续不超过3 min)房性心律失常组(B组)。空白期为3个月。患者术后定期随访心电图及Holter。结果:诱发终点情况:A组74例(55.6%),B组59例(44.4%)。术后平均随访(21.3±10.9)个月,首次消融术后复发45例(A组25例,B组20例)。KaplanMeier生存分析显示两组复发时间无显著差异(P=0.74)。结论 :对于采用环肺静脉电隔离术,以诱发试验阴性为消融终点的阵发性房颤患者,消融终点时不可诱发房性心律失常预后并不优于终点时可诱发短阵(<3 min)房性心律失常者。Objective：This study was designed to investigate prognosis differences among different negative induction test results in patients with paroxysmal atrial fibrillation underwent circumferential pulmonary vein isolation （CPVI）. Methods：We retrospectively studied 133 patients（PTs）who underwent catheter ablation due to paroxysmal atrial fibrillation with the endpoint of non-inducibility （defined as atrial arrhythmias could not be induced or can be induced but lasted less than 3 minutes）. The induction protocol was listed as follows：after successful CPVI,which was defined as completion of ablation set and bidirectional blockade of pulmonary vein （PV）-left atrium （LA）eonduetion,decremented burst stimulation （10 mA,2 ms pulse width）was attempted at coronary sinus orifice （CSo）,and distal of coronary sinus （CSd）from 300 ms to loss of atrium capture （1：1）. If sustained （lasting 〉3 minutes）atrial arrhythmias were induced,the key site would he identified and further ablation performed. According to different negative induction test results at endpoint,patients were divided into group A （atrial arrhythmias could not be induced）and group B （atrial arrhythmias could be induced with duration〈 3 minutes）. All the patients were followed up regularly and receive free ECG/Holter. The blanking period was 3 months. Results：According to induction test results,74 PTs （55.6%） were detected in group A and 59 PTs （44.4%） in group B. After a mean follow-up of （21.3 ± 10.9）months,25 PTs in group A and 20 PTs in group B had AF relapse since the index ablation. Kaplan-Meier survival analysis showed no significant differences of AF relapse ratio between group A and B（P = 0.74）. Conclusion：For patients with paroxysmal AF who underwent CPVI with the endpoint of non-inducibility,those who atrial arrhythmias could not be induced at the endpoint do not promise a better prognosis than those who have short（duration〈 3 minutes）atrial arrhythmias could still be induc

关 键 词：阵发性房颤 环肺静脉电隔离术 诱发试验 

分 类 号：R541.7[医药卫生—心血管疾病]