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目的总结递进式消融术式治疗持续性心房颤动(简称房颤)的手术过程及临床转归。方法采用递进式消融策略治疗连续200例持续性房颤患者,手术终点为通过单纯消融终止房颤。按以下顺序进行消融:环肺静脉前庭消融达肺静脉电学隔离;心房碎裂电位消融;左房顶部和二尖瓣环峡部线性消融;针对房颤转变而成的房性心动过速(简称房速)行激动标测结合拖带技术明确其机制,并进一步消融终止。经术后3个月空白期,对复发房性心律失常(房颤/房速)的患者进行再次消融。结果 136例患者(68%)术中房颤被消融终止,消融终止房颤组首次术后房性心律失常复发率显著低于未终止组[19.9%(27/136)vs 51.6%(33/64),P<0.01],复发患者经再次消融后,平均随访12.8±7.2个月,本组病例总体手术成功率78.5%(157/200)。消融终止房颤组手术总体成功率高于未终止组[(86.8%(118/136)vs 60.9%(39/64),P<0.01)]。结论递进式消融可能是治疗持续性房颤的一种有效术式。
Objective To summarize the surgical procedure and clinical outcome of progressive ablation procedure for treatment of persistent atrial fibrillation (AF). Methods A continuous ablation strategy was used to treat 200 consecutive patients with persistent atrial fibrillation. The end point of surgery was termination of atrial fibrillation by simple ablation. Ablation was performed in the following order: anterior chamber ablation of the pulmonary veins reaching pulmonary vein electrical isolation; atrial fragmentation potential ablation; linear ablation of the left atrium and the mitral valve isthmus; atrial tachycardia (atrial tachycardia) Line excitement mapping combined with towing technology to clarify the mechanism, and further termination of ablation. Three months after the blank phase, recurrent atrial arrhythmia (atrial fibrillation / atrial tachycardia) in patients with re-ablation. Results The atrial fibrillation was terminated in 136 patients (68%) during the ablation. The recurrence rate of atrial arrhythmia after the first ablation in ablation group was significantly lower than that in the non - abortion group [19.9% (27/136) vs 51.6% (33 / 64), P <0.01]. The average follow-up of 12.8 ± 7.2 months after reabsorption in patients with recurrent disease was 78.5% (157/200) in this group. The overall success rate of ablation in terminating AF was higher than that in non-terminating group (86.8% (118/136) vs 60.9% (39/64), P <0.01). Conclusions Progressive ablation may be an effective surgical treatment of persistent atrial fibrillation.