非肺静脉触发灶消融在环肺静脉电隔离治疗阵发性心房颤动中的作用  

Effect of non-pulmonary veins trigger ablation combined with circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation

作　　者：曾现生 张其银 张宇祯[1] 刘明[1] 邹操[1] 惠杰[1] 

机构地区：[1]苏州大学附属第一医院心内科,江苏苏州215006

出　　处：《岭南心血管病杂志》2017年第4期399-404,共6页South China Journal of Cardiovascular Diseases

基　　金：2014年省级自然科学基金(青年科技人才专项资金)(项目编号:BK20140293)

摘　　要：目的观察环肺静脉电隔离(circumferential pulmonary vein isolation,CPVI)基础上,行非肺静脉(non-pulmonary veins,non-PV)触发灶消融治疗阵发性心房颤动(paroxysmal atrial fibrillation,PAF)的效果,探讨non-PV起源的PAF的机制。方法回顾性分析行射频消融(radiofrequency catheter ablation,RFCA)的PAF患者108例,依据电生理检查及RFCA过程分为CPVI组和non-PV+CPVI组,分析腔内电生理以及RFCA过程的特点,所有患者随访1年以上,观察RFCA的成功率。结果入选的108例患者共计行RFCA125人次,14例行2次RFCA,3例行3次RFCA。依据电生理检查及RFCA过程分为CPVI组(88例),non-PV+CPVI组(20例)。术后平均随访1年,共计90例成功,累积成功率83.3%;non-PV+CPVI组18例成功,累积成功率90%;CPVI组72例成功,累积成功率81.8%。Non-PV触发灶中,上腔静脉占15例,界嵴2例,房间隔1例,左心耳1例,右心耳1例。结论 non-PV触发灶是PAF常见原因之一。在CPVI基础上行non-PV触发灶消融治疗PAF的成功率较单纯CPVI更高。Objectives To evaluate the long-term results of non-pulmonary veins （non-PV） trigger ablation combined with circumferential pulmonary vein isolation（CPVI）in patients with paroxysmal atrial fibrillation（PAF）, and explore the mechanism of non-PV origin PAF. Methods In this study,clinical data of 108 patients with PAF for radiofrequency catheter ablation （RFCA） were analyzed. They were divided into two groups by the results of electrophysiological examination and RFCA：the group of CPVI and the group of CPVI combined with non-PV trigger ablation. At an average of 12 months follow-up ,successful rate of RFCA was observed. Results Totally 108 patients were undergone RFCA 125 times in all,while 14 patients were undergone 2 times,3 patients were undergone 3 times. They were divided into two groups by the results of electrophysiological examination and RFCA：CPVI were undergone in 88 patients,and CPVI combined with non-PV trigger ablation were undergone in 20 patients. At an average of one year follow-up,a total of 90 cases succeeded,the rate of success was 83.3%;18 cases in CPVI ＋ non-PV group succeeded,the rate of success was 90%;72 cases in CPVI group succeeded,the success rate was 81.8%. The non-PV foci were originated from superior vena cava （n=15）,crista terminalis （n=2）,atrial septum （n=1）,left atrial appendage（n=1）and right atrial appendage（n=1）. Conclusions Non-PV foci is one familiar cause of PAF. The success rate of atrial fibrillation radiofrequency ablation in group of CPVI combined non-PV trigger foci ablation is higher than that in group of CPVI.

关 键 词：非肺静脉触发灶 阵发性心房颤动 导管射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]