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目的采用双Lasso导管标测技术行环肺静脉及其周围组织隔离预防心房颤动复发。方法13例心房颤动(房颤)患者,男性8例,女性5例,平均年龄为(56±8)岁,行电生理检查和射频导管消融。其中,8例为频发的阵发性房颤(1~20年),5例为持续性房颤(1~4年)。窦性心律下起搏远端冠状静脉窦或房颤发生时,利用电解剖系统进行左心房重建。然后,将两根Lasso多极导管同时置于右(左)上、下肺静脉之内。在距肺静脉口1cm左右处行环肺静脉及其周围组织电隔离。消融终点为左心房-肺静脉/周围组织完全性阻滞,表现为放电时肺静脉电位消失。结果7例阵发性房颤患者在窦性心律下电隔离成功,5例持续性房颤和1例阵发性房颤患者在窦性心律和房颤发生时电隔离成功。3例患者放电时房颤终止:左肺静脉隔离时房颤终止1例,右肺静脉隔离时房颤终止1例,左肺静脉隔离完成后54s自行终止1例。其余3例需体外电转复。消融术时间为(256±56)min,X线曝光时间为(39±11)min。无并发症发生。在术后平均随访(104±50)d,只有1例患者在第71d时出现不典型心房扑动,自行终止。其余12例患者均无房性快速性心律失常复发。结论有明确心电学隔离指标的环肺静脉及其周围组织电隔离是一种安全有效的方法。肺静脉既可为房颤的诱发机制,亦有可能参与房颤的维持机制。
Objective To detect the recurrence of atrial fibrillation by using double Lasso catheter mapping technique to isolate the pulmonary vein and surrounding tissues. Methods Thirteen patients with atrial fibrillation (AF), 8 males and 5 females, with an average age of 56 ± 8 years underwent electrophysiological examination and radiofrequency catheter ablation. Among them, 8 cases of frequent paroxysmal atrial fibrillation (1 to 20 years), 5 cases of persistent atrial fibrillation (1 to 4 years). Sinus rhythm bradycardia distal coronary sinus or atrial fibrillation, the use of electroanatomic system for left atrial reconstruction. Then, two Lasso multipolar catheters were placed simultaneously on the right (left) upper and lower pulmonary veins. In the pulmonary vein from about 1cm around the line pulmonary vein and its surrounding tissue electrical isolation. The ablation end point was a complete block of the left atrium - pulmonary veins / surrounding tissue with the disappearance of the pulmonary venous potential during discharge. Results Seven patients with paroxysmal atrial fibrillation were electrically isolated under sinus rhythm. Five patients with persistent atrial fibrillation and one patient with paroxysmal atrial fibrillation were electrically isolated when sinus rhythm and atrial fibrillation occurred. Atrial fibrillation was terminated during discharge in 3 patients: one died of left atrial fibrillation, one died of right atrial fibrillation, and one case ended 54 seconds after left venous isolation. The remaining 3 cases need to be electroporation. The time of ablation was (256 ± 56) min and the time of X-ray exposure was (39 ± 11) min. No complications occurred. After an average follow-up of (104 ± 50) days, only 1 patient developed an atypical atrial flutter on day 71 and terminated on its own. The remaining 12 patients without atrial tachyarrhythmia recurrence. Conclusion There is a clear indication of ECG isolation of the circumferential pulmonary vein and its surrounding tissue is a safe and effective method of electrical isolation. Pulmonary vein can not only induce the mechanism of atrial fibrillation, may also be involved in the maintenance of atrial fibrillation mechanism.