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目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)消融或(和)线性(Linear)消融进行心房基质改良的疗效。方法回顾性分析156例慢性心房颤动(简称房颤)消融病例,房颤病程2.5±2.3年,左房内径42.4±4.5 mm。根据消融术式改进分为三组CPVI+CFAEs、CPVI+linear和CPVI+CFAEs+Linear组。比较消融术中房颤终止比例及随访疗效。结果三组消融总时间有显著性差异(160±14 min vs 178±9 min vs 241±8min,P<0.01)。CPVI+CFAEs组终止房颤/转变房性心动过速(简称房速)的比例(52.7%)显著高于CPVI+Line-ar组(18.4%),但低于CPVI+CFAEs+Linear组(73.1%)。术后3.1±1.2个月,三组二次消融比例47.3%、51%、38.5%,P=0.43。术后平均随访9.5±1.8个月,三组无房性快速性心律失常复发例数分别为39例(70.9%)、33例(67.3%)和41例(78.8%),P=0.41(服用抗心律失常药物比例25.6%、24.2%和22%,P=0.96)。结论 CP-VI基础上CFAEs消融的房颤终止比例高于单纯线性消融,但低于联合应用CFAEs消融和Linear消融。尽管如此,三组术后二次消融比例和随访成功率无显著性差异。
Objective To evaluate the effects of atrial fibrillation (CEA) ablation or (a) linear ablation on the basis of circumferential pulmonary vein isolation (CPVI). Methods A retrospective analysis of 156 cases of chronic atrial fibrillation (AF) ablation cases, duration of atrial fibrillation 2.5 ± 2.3 years, left atrial diameter 42.4 ± 4.5 mm. According to the improvement of ablation technique, it is divided into three groups of CPVI + CFAEs, CPVI + linear and CPVI + CFAEs + Linear groups. Compare abortion termination rate and follow-up curative effect in ablation. Results The total time of ablation in the three groups was significantly different (160 ± 14 min vs 178 ± 9 min vs 241 ± 8 min, P <0.01). The proportion of patients with atrial fibrillation / atrial tachycardia (52.7%) in CPVI + CFAEs group was significantly higher than that in CPVI + Line-ar group (18.4%), but lower than that in CPVI + CFAEs + %). The postoperative 3.1 ± 1.2 months, three groups of secondary ablation ratio of 47.3%, 51%, 38.5%, P = 0.43. The mean follow-up was 9.5 ± 1.8 months after operation. The incidence of atrial tachyarrhythmia recurrence in the three groups was 39 (70.9%), 33 (67.3%) and 41 (78.8%) respectively, P = 0.41 Antiarrhythmic drug ratios 25.6%, 24.2% and 22%, P = 0.96). Conclusions The termination rate of atrial fibrillation based on CP-VI with CFAEs ablation is higher than that of simple linear ablation, but lower than that of combined use of CFAEs ablation and linear ablation. However, there was no significant difference between the three groups in the rate of postoperative second ablation and follow-up success rate.