心房颤动冷冻球囊和射频消融术后肺静脉传导恢复的电生理特点  

Electrophysiologic characteristics of pulmonary venous conduction recovery after atrial fibrillation cryoballoon or radiofrequency ablation

作　　者：黄俊 李宜富 丁立刚 王靖 廖志勇 李腾 阮焕钧 李华龙 姚焰 HUANG Jun;LI Yi-fu;DING Li-gang;WANG Jing;LIAO Zhi-yong;LI Teng;RUAN Huan-jun;LI Hua-long;YAO Yan(Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen 518000,Guangdong,China;Chinese Academy of Medical Sciences,National Center for Cardiovascular Diseases,Fu wai Hospital,Beijingl00037,China)

机构地区：[1]中国医学科学院阜外医院深圳医院,广东深圳518000 [2]中国医学科学院,国家心血管病中心,阜外医院,北京100037

出　　处：《中国心脏起搏与心电生理杂志》2022年第3期204-207,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 对比分析心房颤动(简称房颤)冷冻球囊和射频消融术后复发患者二次手术中肺静脉传导恢复的特点。方法 选择2017年9月至2019年9月行房颤冷冻球囊或射频消融的患者中随访复发并行二次手术的患者,依据初次消融时的情况分为射频组与冷冻组。采用三维标测系统指导下射频导管消融进行肺静脉再次隔离,记录肺静脉恢复的数量、位置,二次消融的部位。结果 冷冻组19例,射频组25例,二次手术中射频组肺静脉电位恢复数量与冷冻组无差异(2.2±1.1 vs 2.0±0.7,P=0.105),冷冻组与射频组相比左上肺静脉(36.8%vs84.0%,P=0.001)及右上肺静脉(21.0%vs 60%,P=0.01)恢复的比例显著降低,右下肺静脉恢复(84.2%vs 36.0%,P=0.001)的比例显著增高,二次消融手术中补点消融位置共159处,其中射频组补点95处,冷冻组补点64处,射频组在左上肺顶部、左上肺前壁、右上肺顶部、右上肺后壁等位置补点率明显高于冷冻组,射频组在右下肺底部、右下肺前壁等位置补点率低于冷冻组,以上肺静脉均于二次手术中成功补点隔离。二次消融术后随访(13.2±7.7)个月,仍有5例患者复发,其中有1例复发心房扑动。结论 房颤冷冻球囊和射频消融术后复发患者的二次手术中肺静脉传导恢复各有不同的特点,补点消融重新隔离肺静脉安全有效。Objective To compare the characteristics of reconnection of pulmonary vein in patients with recurrent atrial fibrillation after the first cryoballoon or radiofrequency ablation. Methods Fourty-four patients with recurrent atrial fibrillation after cryoballoon or radiofrequency ablation in our hospital on September, 2017 to September, 2019 were enrolled, it was divided cryoballoon ablation group(CA group) and radiofrequency ablation group(RA group) by the primary ablation. All patients received radiofrequency ablation as the second ablation and were followed up. The characteristics of reconnections of pulmonary vein, second ablation targets and atrial fibrillation recurrence were compared between two groups. Results Although no significant difference was found in total of reconnections of pulmonary vein potentials between CA group and RA group(2.2±1.1 vs 2.0±0.7,P=0.105), but less reconnections of potentials in left superior pulmonary vein(LSPV)(36.8% vs 84.0%, P=0.001) and right superior pulmonary vein(RSPV)(21.0% vs 60.0%, P=0.01) were ablated,and more reconnections in right inferior pulmonary vein(RIPV)(84.2% vs 36.0%,P=0.001) occurred in CA group. All reconnections were successfully electrical isolated in the second ablation procedures, during which 159 ablation points were performed, including 95 points in RA group and 64 points in CA group. Re-ablations in roof of LSPV, anterior wall of LSPV, roof of RSPV and posterior wall of RSPV were more common in RA group.While re-ablations in bottom and anterior wall of RIPV were more common in CA group.All patients were followed up for(13.2±7.7)months.Atrial arrhythmias reoccurred in 5patients and 1of those was atrial flutter. Conclusions There were different characteristics of reconnections of pulmonary vein potentials after cryoballoon or radiofrequency ablation.

关 键 词：心血管病学 心房颤动 射频消融 冷冻球囊消融 复发 肺静脉 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]