射频导管消融电学隔离心脏大静脉治疗阵发性心房颤动的临床应用

Cardiac big vein electrical isolation by radiofrequency catheter ablation for the treatment of paroxysmal atrial fibrillation

目的评价射频导管消融电学隔离心脏大静脉预防阵发性心房颤动(房颤)发作的疗效。方法83例患者,男性58例、女性25例,年龄15～76平均(605±185)岁,有阵发性房颤病史2～15年,曾服数种抗心律失常药物疗效不佳。41例患者合并有高血压病,所有患者均无明显器质性心脏病改变。常规行心脏大静脉造影,测量靶静脉直径,将10极肺静脉环状标测导管(Lasso导管)放置在靶静脉开口内05cm处,以Lasso导管为指导,把温控大头电极导管放置于靶静脉开口处行电学隔离。结果83例患者共电学隔离大静脉343条。包括左上肺静脉(LSPV)83条,右上肺静脉(RSPV)83条,左下肺静脉(LIPV)82条,右下肺静脉(RIPV)42条,上腔静脉(SVC)53条,其中2例LSPV与LIPV共同开口。每条肺静脉行1～4段消融(平均每条消融25段),即刻电学隔离成功大静脉337条。随访2～31个月,其中50例停服抗心律失常药物后无房颤发生,13例患者房颤发作明显减少,20例患者房颤发作消融前后无明显变化。并发症有2例术中出现左侧大量胸腔积血,1例心肺复苏5天后出现脑死亡。发现肺静脉狭窄21例,其中轻度狭窄15例,重度狭窄6例,无肺静脉闭塞。结论(1)成功的心脏大静脉电学隔离治疗阵发性房颤的总有效率达到75%左右;(2)由于很难确定靶肺静脉,成功电学隔离各心脏大静脉有可能提高治愈率;(3)

Objective The effects of cardiac big vein electrical isolation to treat paroxysmal atrial fibrillation (PAF) were reviewed. Methods 83 patients [age (60 5±18 5) years, 58 males, 25 females] were referred for vein electrical islation by radiofrequency catheter ablation to treat drug refractory PAF were studied. Guided by circular mapping catheter (Lasso catheter), radiofequency lesions were applied around the circumference of the cardiac big veins at the ostia until the complete electrical disconnections between the atria and veins developed. Results Successful electrical isolation was obtained in th 343 cardiac big veins of 83 pantients, including 83 LSPV and 83 RSPVs and 82 LIPVs and 42 RIPVs and 53 SVCs. After a follow up of 2～31 months, 50 patients remained free of PAF without medication, and another 13 patients experienced remarkable reduction of PAF episodes. Complications occurred in 23 patients, including in 2 hemothorax, 21 pulmonary vein stenosis. Conclusion (1) The cardiac big veins could be successfully electrically disconnected from atria through radiofrequency catheter ablation techniqe in patients with PAF, the recurrence of PAF can be controlled or cured in more than 75% of patients; (2)The all cardiac big veins be successfully electrically disconnected may increase success rate; (3)The complications should be carefully avoided during the procedure.