消融指数指导下持续性心房颤动左心房后壁隔离方法  

Ablation index guided isolation of left atrial posterior wall in persistent atrial fibrillation

作　　者：刘丽凤 刘铮 刘旭[2] 王云龙 梁卓 刘小青 杨新春 LIU Lifeng;LIU Zheng;LIU Xu;WANG Yunlong;ZHUO Liang;LIU Xiaoqing;YANG Xinchun(Heart Center,Beijing Chao Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,100029 [2]首都医科大学附属北京朝阳医院心内科,100029

出　　处：《心肺血管病杂志》2022年第2期116-120,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81700293)。

摘　　要：目的:应左心房后壁隔离是目前持续心房颤动消融的常见术式之一,临床实践中发现顶部线和底部线消融达到后壁隔离存在一定难度。我们探索消融指数(AI)指导下的左心房后壁隔离电生理特点和方法。方法:我们连续入选20例在我中心行心房颤动射频消融的长程持续性心房颤动患者,AI指导下行常规双肺静脉电隔离以及左心房后壁顶部线和底部线消融。双线消融后如后壁仍然存在电位,行左心房后壁电压标测,指导后壁内消融,直到后壁达到传入和传出双向阻滞。结果 :AI指导下左心房后壁直接双线隔离率35%,65%双线消融后后壁内仍然有电位。65%患者后壁内电压标测发现后壁内存在局部高电压区,平均在高电压区域消融5.7个点可以简单快速高效安全的达到左心房后壁完全电隔离,并且没有造成严重食道损伤。后壁中间区域需要消融点数最多,占后壁内总消融点数的84%。结论 :AI指导下可以安全高效的完成左心房后壁隔离,但65%的患者需要在后壁内电压标测指导下平均消融5.7个点达到后壁隔离。Objective: Left atrial(LA) posterior wall isolation(PWI) is commonly used with persistent atrial fibrillation(AF) ablation. However, potentials are often still recorded in the posterior wall after pulmonary vein isolation(PVI), roof linear ablation, and bottom linear ablation in clinical practice. We aimed to explore the methodological approach of PWI under the guidance of(ablation index AI). Methods:Twenty patients who attended our center with long-standing persistent AF were retrospectively analyzed. Routine PVI and roof and bottom linear ablation was completed under the guidance of AI. Voltage mapping was used to guide ablation inside the posterior wall until bidirectional block was achieved, if potential still existed after linear ablation. Results: The first-pass success rate of PWI was 35%. In the remaining 65% of patients with posterior wall electrograms, voltage mapping revealed a focal high-voltage area in the posterior wall, in which an average of 5.7 points of ablation achieved complete PWI without serious esophageal injury. The middle zone contained 84% of the additional posterior wall ablation points. Conclusions: PWI could be performed safely and effectively under the guidance of AI, with an average of 5.7 additional ablation points in the posterior wall in 65% of patients under the guidance of voltage mapping.

关 键 词：心房颤动 导管消融 后壁隔离 

分 类 号：R54[医药卫生—心血管疾病]