长期持续性心房颤动导管消融策略的临床研究

Strategies of catheter ablation in patients with long-standing persistent atrial fibrillation

目的：比较导管消融治疗长期持续性心房颤动（房颤）不同消融策略的临床疗效。方法2009年5月至2011年3月,入选240例于上海市胸科医院房颤诊治中心接受三维标测系统（ Carto）指导下的导管消融治疗的长期持续性房颤患者,男138例,女102例。随机分为3组,A组：80例患者行环肺静脉前庭电隔离（ CPVA）及心房碎裂电位（ CFAE）消融,B组：80例患者行CPVA＋CFAE＋左心房线性消融,C组：80例患者行CPVA＋CFAE＋左心房线性消融＋三尖瓣峡部线性消融,消融后未能转复窦性心律患者均行直流电复律。消融术后随访心电图和24 h动态心电图评价疗效,比较3组的安全性及临床效果。结果所有患者均顺利完成导管消融术,平均随访（36±7）个月,单次消融后成功率 A 组37．5%、B组52．5%、C组55．0%,多次消融后成功率A组60．0%、B组75．0%、C组76．3%（ P〈0．05）。各组间并发症发生率差异无统计学意义。结论对于长期持续性房颤患者,在CPVA＋CFAE的基础上行左心房线性消融有助于提高成功率,而三尖瓣峡部线性消融效果不确切。

Objective To evaluate three ablation strategies in patients with long-standing persistent at-rial fibrillation（AF）and to explore the best procedural endpoint. Methods A total of 240 patients（138 males）with long-standing persistent AF from May 2009 to March 2011,undergoing catheter ablation（guided by Carto） were enrolled. The patients were divided into three groups according to the evolution of ablation strate-gies：CPVA＋CFAE ablation（ group A） ,CPVA＋CFAE＋LA Linear ablation（ group B） ,CPVA＋CFAE＋LA Linear lesions＋cavotricuspid isthmus（ CTI） ablation（ group C） . Directcurrent cardioversion was performed upon CPVA, CFAE elimination and completion of linear lesions. The complications and subsequent clinical effectiveness were compared among the three groups. Results Two hundred and forty patients underwent catheter ablation. During the follow-up（36±7）months period. After the first ablation procedure,30 patients（37.5%）in group A,42 （52.5%）in group B,and 44（55.0%）in group C were in sinus rhythm without antiarrhythmic drugs. After multiple procedures,sinus rhythm was maintained in 48（60. 0%）patients in group A,60（75. 0%）in group B, and 61（76. 3%） in group C（P〈0. 05）. There were no significant difference in complications among three groups. Conclusions ln long-standing persistent AF,complete LA linear lesions improved long-term single and multiple procedure outcomes. Additional CTI ablation was of no benefit for the long-term outcome in patients with long-standing persistent AF.