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目的探讨环状电极(Lasso电极)标测诱发阵发性房颤的肺静脉电位的电生理特点并对射频消融靶点进行评介。方法16例阵发性房颤者在Lasso电极标测寻找优势肺静脉电位(PVP),温控消融放电。结果起源于肺静脉的局灶性房颤其电生理特征包括:①异位激动灶主要分布于两上肺静脉。②肺静脉内可观察到从肺静脉内至心房传导阻滞。消融成功的靶点与体表心电图P′波提前(74±33)ms。成功隔离38条肺静脉:其中左上肺静脉16条,右上肺静脉12条。术程(186.7±63.8)min,X线曝光时间(51.5±15.0)min。术后随访1～12个月,11例(68.7%)无需药物而维持窦性心律。结论阵发性房颤异位起源点大多数位于左房肺静脉,起源于肺静脉的局灶性房颤有其特殊的电生理表现。
Objective To investigate the electrophysiological characteristics of pulmonary vein potential induced by ring electrode (Lasso electrode) detection and to evaluate the radiofrequency ablation target. Methods 16 cases of paroxysmal atrial fibrillation in Lasso electrode mapping to find the superior pulmonary venous potential (PVP), temperature controlled ablation discharge. Results The electrophysiological characteristics of focal atrial fibrillation originated in the pulmonary veins include: ① The ectopic focus is mainly located on the two pulmonary veins. ② pulmonary veins can be observed from the pulmonary veins to atrial conduction block. Successful ablation of the target and surface ECG P ’wave early (74 ± 33) ms. 38 pulmonary veins were successfully isolated: 16 of the left upper pulmonary veins, 12 of the right upper pulmonary veins. The operation time (186.7 ± 63.8) min and X-ray exposure time (51.5 ± 15.0) min. All patients were followed up for 1 ~ 12 months. Eleven patients (68.7%) maintained sinus rhythm without medication. Conclusions Most ectopic origin of paroxysmal atrial fibrillation is located in the left atrium pulmonary veins. Focal atrial fibrillation originating in pulmonary veins has its special electrophysiological findings.