在心房颤动发作时行肺静脉隔离治疗

The methodological study of segmental isolation of pulmonary veins during atrial fibrillation

目的 探讨在心房颤动 (房颤 )发作时 (包括部分持续性房颤 )进行肺静脉节段性电隔离的方法 ,评价其安全性及有效性。方法 选择 5例持续半年以内的房颤病例及 4例发作频繁的房颤病例 ,在房颤发作时行肺静脉电隔离。通过一次性房间隔穿刺送入标测及消融导管 ,行左房或肺静脉选择性造影 ,显示肺静脉后 ,标测肺静脉电位活动 ,并行节段性隔离。结果 9例患者共 2 9条肺静脉 ,肺静脉电位特征明确 ,在肺静脉环状电极标测到较左房电位振幅高尖 ,频率更快的肺静脉电位。选择最高尖处或频率最快处电位开始节段性消融。肺静脉电位 10 0 %消失 ,无并发症发生。 7例手术中或术后转为窦性心律。 2例电复律恢复窦性心律。结论 房颤发作时行肺静脉节段性电隔离方法安全。

Objective To investigate the efficacy and safety of segmental electrical isolation of pulmonary veins (PVs) during atrial fibrillation (AF) Methods Nine patients were included, of whom 4 had recently persistent AF (3～4 months) and 5 suffored from paroxysmal AF occurred AF frequently We adopted one transseptal procedure Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum RF ablation was applied at the pulmonary vein potential (PVP) breakthrough using thermo control RF catheter during AF Results Twenty nine PVs were targeted for segmental RF ablation and isolated completely PVPs in target PVs were in higher spike and more frequent than left atrial potentials There were no complications associated with the procedure Seven patients were converted to sinus rhythm during the procedure Two patients restored sinus rhythm by cardioversion Conclusion It is suggested that the method of segmental PV isolation during AF is safe and has higher success rate It is not necessary to stop antiarrhymic drugs before RF ablation This study provides a reliable method for segmental electrical isolation of pulmonary veins in patients with persistent AF