老年人阵发性心房颤动的导管消融治疗

Catheter Ablation for the Treatment of Paroxysmal Atrial Fibrillation in the Elderly

为评价老年人阵发性心房颤动 (PAF)行导管消融治疗的可行性和疗效 ,选择药物无法控制或不能耐受的PAF患者 5 6例 ,男 4 1例、女 15例 ,年龄 6 5 .7± 10 .1(6 0～ 74 )岁 ,无器质性心脏病 4 6例 ,合并高血压 7例 ,高血压及糖尿病 1例 ,高血压及冠心病 1例 ,冠心病 1例。均经食管超声心动图检查排除左房血栓。据消融技术的演进及患者入选的时间顺序 ,采用不同的消融方法 (点消融术、超声球囊肺静脉电隔离术、肺静脉节段性消融电隔离术 )。 3～ 6个月后评价疗效。结果 :5 6例患者 ,5 5例完成消融术 :点消融术 4例 ,成功 1例 ,无效 2例 ,心包积血 1例 ;超声球囊肺静脉电隔离术 14例 ,成功 7例 ,有效 5例 ,无效 2例 ,无肺静脉狭窄 ;肺静脉节段性消融电隔离术 37例 ,成功11例 ,有效 2 3例 ,无效 3例 ,左下肺静脉开口 >30 %狭窄 1例。结论 :导管消融治疗老年人PAF是安全有效的 ,肺静脉电隔离术使疗效明显提高 ,但仍未令人满意。

The purpose of this study was to evaluate the feasibility and efficacy of catheter ablation for the treatment of paroxysmal atrial fibrillation (PAF) in the elderly. 56 senile patients (41 male, 65.7±10.1 years) with PAF refractory or unbearable to multiple antiarrhythmic drugs were consecutively included. 46 cases were free of any structural heart disease, 7 with hypertension, 1 with hypertension and diabetes, 1 with hypertension and coronary artery disease, another 1 had coronary artery disease. Thrombus in the left atrium was excluded by transesophageal echocardiography in all patients. 3 different ablation procedures were applied consecutively: focal ablation, ultrasound balloon isolation of pulmonary veins (PVs), and segmental isolation of the PVs. With a mean follow-up of 3～6 months, efficacy of ablation was evaluated. Results: 55 patients underwent catheter ablation procedure. Focal ablation (n=4): 1 achieved success, 2 were inefficacious, and 1 developed hemopericardium. Ultrasound isolation of PVs (n=14): 7 achieved success, 5 attained improvement, and 2 were inefficacious. PV stenosis was not observed. Segmental isolation of PVs (n=37): 11 achieved success, 23 attained improvement, and 3 were inefficacious. 1 developed pulmonary vein orifice stenosis for more than 30%. Conclusion: Catheter ablation for the treatment of PAF in the elderly is safe and efficacious, but so far the efficacy of catheter ablation is not satisfying.