持续性心房颤动2C3L联合Marshall静脉无水乙醇化学消融的初步经验  

“2C3L” approach plus adjunctive ethanol infusion of the vein of Marshal for persistent atrial fibrillation

作　　者：桑才华[1] 李梦梦[1] 鲁志兵 龙德勇[1] 王伟[1] 汤日波[1] 蒋晨曦[1] 杜昕[1] 董建增[1] 马长生[1] SANG Caihua;LI Mengmeng;LU Zhibing;LONG Deyong;WANG Wei;TANG Ribo;JIANG Chenxi;DU Xin;DONG Jianzeng;MA Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029 [2]武汉大学中南医院心内科

出　　处：《心肺血管病杂志》2020年第6期650-656,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:总结持续性心房颤动2C3L消融策略联合Marshall静脉(VOM)无水乙醇化学消融的初步经验。方法:对连续16例持续性心房颤动按以下策略进行消融:①VOM无水乙醇化学消融;②"2C3L"消融,即双侧环肺静脉消融、二尖瓣峡部线消融及冠状静脉内消融、左心房顶部线消融、三尖瓣峡部线消融;③电复律转复窦性心律,验证肺静脉隔离及消融径线传导阻滞。结果:平均手术时间(205±65.2)min,透视时间(17.8±9.1)min,放电时间(52.1±10.7)min;心房颤动术中消融终止率31.3%,术毕即刻诱发率6.3%。16例患者中,15例完成VOM无水乙醇化学消融,所有患者均实现肺静脉隔离、消融线完全传导阻滞。无围术期严重并发症发生,平均随访6个月,1例复发心房扑动,其余15例均维持稳定窦性心律。结论:持续性心房颤动2C3L联合VOM无水乙醇化学消融安全、可行,近期疗效满意。Objective: To describe our initial experience on the radiofrequency catheter ablation(CA) of persistent atrial fibrillation(AF) using 2 C3 L approach plus adjunctive ethanol infusion of the vein of Marshal(EI-VOM). Methods: Sixteen patients with persistent AF undergoing RFCA in our hospital were consecutively enrolled. The procedural strategy and endpoints were as following: ①EI-VOM for a total amount of 6 to 12 mL;② wide antral pulmonary vein ablation and isolation;③three anatomical isthmuses(mitral isthmus, left atrial roof line and tricuspid isthmus) block. Inducibility testing was performed after the lesion set achieved. Results: After an average of(205±65.2)min of procedural time,(17.8±9.1)min of fluoroscopy time, all patients achieved the established procedural endpoints. AF was terminated in 5 out of 16 patients during the procedure and inducibility testing was negative in 15/16 of the patients. Successful EL-VOM was achieved in 15 patients without perioperative complications. After a median of 6-month follow-up, 15 patients were free from atrial arrhythmia recurrence. Conclusions: Adjunctive EI-VOM plus 2 C3 L approach is feasible and safe to achieve a desirable isthmus block in the catheter ablation of persistent AF and provide a good short-term outcome.

关 键 词：持续性心房颤动 导管消融 Marshall静脉 化学消融 

分 类 号：R54[医药卫生—心血管疾病]