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目的探讨个体化消融原则的临床效果及右房的作用。方法房扑/房颤患者82例,男性42例,女性40例,年龄18～77(48.5±10.3)岁,左房内径26～52(35.4±5.3)mm。其中53例为阵发性房颤,14例为持续性房颤,15例为典型房扑。所有患者在Carto指导下进行个体化消融原则,以房扑/房颤被终止且不被诱发、肺静脉电位消失为消融终点。随访成功的定义为未服用抗心律失常药物、无任何症状性房性心律失常发作至少3个月。结果①随访时间3～28(13.4±3.3)个月,房扑和阵发性房颤消融随访成功率88.2%,持续性房颤仅为57.1%(P<0.05)。2例有心包压塞,1例合并假性动脉瘤。无肺静脉狭窄等血管严重并发症。②阵发性房颤53例,其中10例为局灶性房早、短阵房速诱发的房颤(4例病灶位于右房内),8例行靶静脉线性消融,这类亚组手术无任何心律失常发作。其余43例阵发性房颤患者均行环肺静脉线性消融术,合并典型(4例)和非典型(6例)房扑者外加三/二尖瓣峡部消融。③15例典型房扑(4例为持续性房扑)患者,均行三尖瓣峡部消融,4例合并房颤者外加双侧肺静脉线性消融。④14例持续性房颤均经历了消融由房颤转变为房扑的过程,6例被消融终止和8例电复律复为窦律,半数分别进行了三/二尖瓣峡部消融和冠状静脉窦内消融,2例合并了起源于右房的房扑和房速。结论Carto指导下房颤/房扑个体化消融可获得较好的临床疗效,右房的作用不能忽略。
Objective To explore the clinical effect of individualized ablation principle and the effect of right atrium. Methods 82 cases of atrial flutter and atrial fibrillation were included in this study. There were 42 males and 40 females, aged from 18 to 77 (48.5 ± 10.3) years. The left atrial diameter ranged from 26 to 52 (35.4 ± 5.3) mm. 53 cases of paroxysmal atrial fibrillation, 14 cases of persistent atrial fibrillation, 15 cases of typical atrial flutter. All patients under the guidance of Carto the principle of individualized ablation to atrial flutter / atrial fibrillation was terminated and not be induced, pulmonary venous potential disappears as the end of ablation. Follow-up success was defined as taking no anti-arrhythmic drug and without any symptomatic atrial arrhythmia attack for at least 3 months. Results The follow-up success rate was 88.2% and persistent AF was only 57.1% (P <0.05). The follow-up time ranged from 3 to 28 (13.4 ± 3.3) months. 2 cases of pericardial occlusion, 1 case of false aneurysm. No serious vascular complications such as pulmonary stenosis. ② 53 cases of paroxysmal atrial fibrillation, of which 10 cases of focal atrial fibrillation, short atrial tachycardia induced atrial fibrillation (4 lesions located in the right atrium), 8 cases of target vein ablation, such sub-group surgery No arrhythmia. The remaining 43 patients with paroxysmal atrial fibrillation underwent circumferential pulmonary vein ablation, a combination of typical (4 cases) and atypical (6 cases) atrial flutter plus triple / mitral isthmus ablation. ③ Fifteen patients with typical atrial flutter (4 patients with persistent atrial flutter) were treated with tricuspid isthmus ablation, 4 patients with atrial fibrillation plus bilateral pulmonary vein ablation. 14 cases of persistent atrial fibrillation have undergone the process of ablation from atrial fibrillation to atrial flutter ablation, 6 cases were terminated by ablation and 8 cases of electroretinography were sinus rhythm, half were three / mitral isthmus ablation and coronary vein Sinus ablation, 2 patients combined atrial flutter and atrial tachycardia originated in the right atrium. Conclusion Carto-guided atrial fibrillation / atrial flutter individualized ablation can get better clinical efficacy, the role of the right atrium can not be ignored.