单环消融术式用于下肺静脉共干患者肺静脉隔离的临床经验  

Clinical experience of box lesions in pulmonary vein isolation in patients with a common inferior pulmonary vein

作　　者：唐成[1] 张劲林[1] 程光辉[1] 张勇华[1] 黄尾平 杨新玮 李希 张霞 苏晞[1] Tang Cheng;Zhang Jinlin;Cheng Guanghui;Zhang Yonghua;Huang Weiping;Yang Xinwei;Li Xi;Zhang Xia;Su Xi(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022,China;Department of Cardiology,Fifth People’s Hospital,Dongguan 523900,China)

机构地区：[1]武汉亚洲心脏病医院心内科,430022 [2]东莞市第五人民医院心内科,523900

出　　处：《中华心律失常学杂志》2020年第1期27-33,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的对侧肺静脉共干是罕见的肺静脉解剖变异。心房颤动(房颤)患者进行肺静脉隔离应根据患者肺静脉解剖特点制定个体化手术策略。本研究探讨了武汉亚洲心脏病医院心内科在下肺静脉共干的患者中采用盒式单环消融进行肺静脉隔离的安全性及可行性。方法入选2018年1月至11月在武汉亚洲心脏病医院心内科住院的有房颤消融适应证、左右下肺静脉共干并行房颤导管消融手术患者5例,进行回顾性观察性研究。所有患者行房间隔穿刺将冷盐水灌注消融导管送至左心房,在三维标测系统指导下,以功率模式25~35 W,43℃,流速30 ml/min行盒式消融肺静脉单环隔离。记录患者的一般信息及术中资料,包括手术并发症、即刻手术效果、手术时间、X线曝光时间及曝光量,术后1、3、6个月随访患者症状、心电资料并记录随访期内并发症。结果阵发性房颤4例,持续性房颤1例,CHA2DS2-VASC评分为3.8±1.8,HAS-BLED评分为1.8±0.6;双侧下肺静脉共干左右缘内径(32.7±1.71)mm,上下缘内径(25.7±4.50)mm,呈椭圆形。经过消融5例患者均达到双侧肺静脉完全电隔离,即刻消融成功率为100%,无并发症,手术时间82~188(141.8±33.8)min,X线曝光时间15~46(25.8±13.1)min,X线曝光量277~654(439.6±144.7)mGy。随访6~10个月,均维持窦性心律。结论对于下肺静脉共干的房颤患者,采用盒式消融单环隔离肺静脉,具有较好的安全性、可行性及有效性。Objective A common pulmonary vein(CIPV)is a rare anatomical variant.Individualized strategy in pulmonary vein isolation(PVI)should be recommended in light of the anatomical feature of pulmonary veins(PV).This study was to report about our experiences concerning Box lesion in achieving PVI in patients with confluent inferior pulmonary veins.To study the safety,feasibility and efficiency of the Box lesions.Methods Five patients with coalescence of inferior PV in Wuhan Asia Heart Hospital from Jan 2018 to Nov 2018 were enrolled in the study.All of the five patients who underwent PV isolation guiding by a 3D mapping system were diagnosed as presenting coalescent inferior PV.Ablation procedure was performed as described previously.The Box lesion was obtained by encircling all PV by an irrigating ablation catheter guided by a 3D mapping system.The radiofrequency ablation(RF)energy was delivered as power-coupled mode with the power limit of 25-35 W,43℃and flow-rate of 30 ml/min.Complete isolation of pulmonary veins was deemed as the endpoint of ablation.The general information of patients and data of measurement during radiofrequency ablation(RFCA),including complications,immediate PVI effect,operation time,fluoroscopy time and radiation dose were collected.We followed up these patients at 1 month,3 months and 6 months after RFCA to record all symptoms,Electrocardiogran(ECG)data and complications.Results There were 4 cases of paroxysmal atrial fibrillation and 1 case of persistent atrial fibrillation.The CHA2DS2-VASC score was 3.8±1.8,and the HAS-BLED score was 1.8±0.6.The left-right diameter of CIPV was(32.7±1.71)mm,and the upper-down diameter of CIPV was(25.7±4.50)mm Complete PVI was achieved in all of these five patients.Operation time was 82-188(141.8±33.8)min,fluoroscopy time was 15-46(25.8±13.1)min and radiation dose was 277-654(439.6±144.7)mGy.No minor or major complications were observed peri-procedures.During 6-10 months of follow-up,no event of atrial fibrillation was detected.Conclusion Box lesion is

关 键 词：心房颤动 下肺静脉共干 射频消融 

分 类 号：R541[医药卫生—心血管疾病]