局灶驱动在心房颤动机制中的意义

The Role of Focal Driving Activity in Paroxysmal Atrial Fibrillation.

根据导管消融的不同方法、消融过程中的特征表现和消融结果阐明局灶驱动在阵发性心房颤动 (简称房颤 )机制中的作用。自 1998年 8月至 2 0 0 4年 5月共对 2 6 9例药物治疗无效的阵发性房颤患者进行了导管消融治疗 ,男194例、女 6 5例 ,年龄 2 9～ 75岁。A组 (n =5 3) :肺静脉内局灶消融组 ,早期病例采用这种方法消融 ;B组 (n =78) :消融过程中无房颤或仅有房颤短暂发作、有房颤但是房颤不自行终止或不因消融终止 ;C组 (n =12 3) :消融过程中有明确消融终止房颤 ,消融方法包括环状标测电极指导下节段性消融肺静脉电隔离、超声球囊肺静脉口环状消融术、三维标测指导下肺静脉口外环状消融术及补充应用的局灶消融 ;D组 (n =15 ) :消融仅限于房颤局灶 ,除三尖瓣环 下腔静脉峡部外未在其它部位消融 ,房颤局灶根据标测确定。房颤治疗成功的定义是无房颤发作或房颤发作显著减少。结果 :①近期成功率B、C和D组分别为 4 1.0 3% (32 / 78) ,74 .80 % (92 / 12 3)和 10 0 % (15 / 15 ) ,D组与C、B组、B组与C组相比差异均具有显著性 ,P <0 .0 5。②中期成功率A、B、C和D组分别为 2 8.30 % (15 / 5 3) ,34.6 2 % (2 7/ 78) ,6 5 .0 4 % (80 / 12 3)和 80 % (12 / 15 )。D组与A、B组 ;C与A、B组差异具有显著性 ,P <0 .

To investigate the role of focal driving activity in paroxysmal atrial fibrillation(AF) through focal ablation,269 consecutive patients with paroxysmal AF refractory to drug therapy were included in this study (male 194 cases, mean age of 54±15 years old). They were divided into 4 groups. Group A(n=53):focal ablation within the pulmonary veins during our initial exploration in this field; Group B(n=78):No AF or only transient AF during procedures were found, or existed AF could not be terminated with ablation;Group C(n=123):AF terminated during ablation, mapping guided segmental pulmonary vein isolation, or circumferential pulmonary vein isolation with ultrasound catheter or under 3 dimentional mapping system were applicated in this group. If pulmonary vein isolation could not be achieved in later group, extra focal ablation could be administered;Group D (n=15):Ablation was only applied to focal source of AF, which was stable during procedure.Definition of success therapy: No AF or reduced occurrence of AF post procedure. Results:①Short term success rate was 41.03%(32/78),74.80%(92/123),and 100%(15/15)in group B,C, and D, respectively. A significant difference was observed between each group with P<0.05.②Mid-term success rate was 28.30%(15/53),34.62%(27/78),65.04%(80/123),and 80%(12/15)in group A, B, C,and D , respectively. A significant difference was observed between group D and group A, or B; group C and group A or B , respectively, P<0.05,No significant difference was demonstrated between group D and group C,group A and group B, P>0.05.Conclusion:Focal source plays a pivotal role in the development of AF.