持续性心房颤动线性消融及不同阻滞线与复发的关系分析

Prognosis of patients with persistent atrial fibirllaiton in relation to left atrial linear ablation and different blocked lines

目的探索持续性心房颤动线性消融及不同阻滞线与临床复发之间的关系。方法入选2009年5月至2010年7月因持续性房颤首次行导管射频消融术的患者440例。年龄(61±10)岁,男性308例,房颤病程(4.1±5.1)年。在CARTO三维标测系统引导下行环同侧肺静脉前庭电隔离术、心房复杂碎裂电位消融术及必要的线性消融。结果 440例患者均顺利完成射频消融术,142例(32.3%)行线性消融达双向阻滞(线性消融组),298例(67.7%)未行线性消融(非线性消融组)。线性消融组中房顶阻滞线85例(59.9%),二尖瓣峡部线阻滞18例(12.7%),二尖瓣峡部和房顶阻滞线均达双向阻滞39例(27.4%)。术后随访(18.4±5.1)月,消融次数1(1～3)次。线性消融组122例(85.9%)未见复发;非线性消融组225例(75.5%)未见复发(P=0.012)。亚组分析房顶线消融组74例(87.1%)未见复发,二尖瓣峡部线消融组15例(83.3%)未见复发,房顶线和二尖瓣峡部线消融组33例(84.6%)未见复发,两两组间比较差异无统计学意义。结论左心房线性消融并达双向阻滞能进一步提高消融成功率;左心房内不同的消融阻滞线对复发的影响需要更深更广泛的探讨。

Objective To investigate the effects of left atrial linear ablation and different blocked lines on prognosis of patients with persistent atrial fibrillation （AF） following catheter ablation. Methods Between May 2009 and July 2010, 440 patients with similar clinical conditions （61 ± 10 years, male 308, duration of persistent AF 4. 1 ± 5.1 years） were enrolled to undergo circumferential pulmonary vein isolation （CPVI） plus additional linear or complex fractionated atrial electrograms （CFAEs） ablation under the guidance of CARTO system. Results All catheter ablation procedures were performed successfully in 440 cases, The primary endpoint was reached in 142 （32. 3% ） patients of completely bi-directional block gourp with linear lesion ablation and 298 （67.7%） patients without linear leasion ablation. In the linear lesion ablation group, bi-directional block of roof line was achieved in 85 of 142 cases （59. 9% ） , mitral isthmus （MI） line in 18 cases （ 12. 7% ）, both roof and MI line in 39 cases （27.4%）. After a period of （ 18.4 ± 5.1 ） months follow-up and ablation number of 1 （ 1 - 3 ） per patient, the total success rate was 85.9% with linear lesion ablation, compared with 75.5% without recurrence （P = 0. 012）. 87. 1% of cases with roof line block, 83. 3% with MI block, 84. 6% with both roof and MI block were completely free from AF recurrence （P 〉 0. 05, between with two subgroups）. Conclusions In patients with persistent AF, CPVI puls CFAE ablation and additional linear lesions reached the better results than only CPVI plus CFAE ablaiton. The effects of different blocked lines on the prognosis were unconfirmed and required the more and further prospective studies.