环肺静脉消融电隔离治疗持续性心房颤动的疗效观察

The clinical evaluation of circumferential pulmonary vein isolation in cases with persistent atrial fibrillation

目的评价EnSite-NavX系统引导下环肺静脉消融电隔离结合左心房线性消融治疗持续性／永久性心房颤动（房颤）的安全性和疗效。方法入选2004年9月至2005年8月持续性／永久性房颤患者60例，男性43例，女性17例，平均年龄59．2±13．6（39～77）岁，平均房颤持续时间4±6年（6个月～24年）。左心房内径43．2±6．4（42～58）mm。在EnSite-NavX系统引导下行环肺静脉消融达到肺静脉电隔离，并进行左心房后壁和二尖瓣峡部线性消融。结果60例均顺利完成手术。平均手术时间170±34（150～240）min，X线透视时间23±10（12～45）min。环左肺静脉消融电隔离率为83．3％，环右肺静脉消融电隔离率为78．3％，其余病例结合节段性消融达到肺静脉电隔离。消融终止房颤7例；转变为房性心动过速（房速）/心房扑动（房扑）5例，其中2例消融终止。48例电转复成功，术后房扑／房速10例（16．7％），8例自愈，2例再次消融成功。术后平均随访6．5±3．2（4～11）个月，43例（71．7％）无房颤发作（其中18例服用抗心律失常药物）。并发症：股动脉假性动脉瘤1例，经保守治疗痊愈。结论EnSite—NavX系统引导下环肺静脉消融电隔离结合左心房线性消融治疗持续性／永久性房颤安全性好，疗效可以接受。

Objective To evaluate the safety and effectiveness of circumferential pulmonary vein （PV） isolation in cases with persistent/permanent atrial fibrillation （AF） guided by the EnSite-NavX system. Methods Sixty cases （43 males, mean age 59.2＋ 13.6 years） with persistent/permanent AF were enrolled from September 2004 to August 2005. The mean duration of AF was 4 ＋ 6 years （6 months - 24 years）. The mean left atrium diameter was 43.2 ＋ 6.4 （42- 58）mm. Circumferential PV isolation was performed guided by the EnSite-NavX system, combined with linear ablation of the superior-posterior wall of left atrium and mitral isthmus. Results All 60 cases underwent the procedure successfully, with the mean procedural time 170＋ 34 （ 150- 240）min and the mean fluoroscopic time 23 ＋ 10 （ 12 - 45 ） min. The pulmonary vein isolation rate for the left ipsilateral PVs was 83.3% and was 78.3% for the right PVs. Segmental ostial ablation was applied for the rest cases. AF was terminated in 7 cases and was converted to atrial tachycardia （AT） or atrial flutter （AFL） in 5 cases. Sinus rhythm was restored by cardioversion in 48 cases. Post-ablation AT/AFL was documented in 10 cases （16.7%） which diminished automatically in 8 cases, and was abolished by re-ablation in 2 cases. After a mean of 6.5 ＋ 3.2 （4- 11） months of follow-up, 43 cases （71.7%） were free of AF （18 cases with anti-arrhythmic drugs）. Complications： pseudo-aneurysm of femoral artery was found in 1 case and was cured after proper treatment. Conclusion Circumferential PV isolation and combination with left atrial linear ablation guided by the EnSite- NavX system was safe and effective for eliminating persistent/permanent AF.