经静脉体内心房除颤治疗慢性心房颤动的临床应用

Clinical use of transvenous atrial defibrillation in patients with chronic atrial fibrillation

目的评估经静脉体内心房除颤治疗慢性心房颤动(房颤)的技术方法、功效、安全性及可行性,确定慢性房颤患者体内心房除颤的阈值。方法经静脉穿刺分别将除颤导管植入右房冠状静脉窦,由体外心房除颤器自右至左方向发放与 R 波同步的双相低能量电流转复慢性房颤患者76例,记录并确定成功除颤的最小能量及电压作为心房除颤阈值(ADFT)。结果 93.4%慢性房颤患者可急性成功转复窦性心律,其体内心房除颤阈值为4.29±1.89 J,326.1±62.4 V。结论经静脉体内心房除颤是慢性房颤更为有效安全的治疗方法,有助于体内心房除颤器的进一步应用。

Objective To introduce the techniques and to assess the efficacy,safety of low energy transvenous atrial defibrillation in patients with chronic atrial fibrillation,as well as to determine the atrial defibrillation threshold(ADFT)in chronic atrial fibrillation group.Methods Transvenous atrial defibrilla- tion were performed in 76 patients with chronic atrial fibrillation by delivering R wave synchronised bipha- sic low energy shocks with right atrial to coronary sinus vector.The lowest energy and voltage resulting in successful defibrillation were considered as ADFT.Results 93.4% patients(71/76)of chronic atrial fib- rillation were reverted to sinus rhythm with the low energy transvenous atrial defibrillation.The mean de- fibrillation threshold was 4.29±1.89 J,326.1±62.4 V.Conclusion Transvenous atrial defibrillation is a safe,effective and reliable way to treat the chronic atrial fibrillation even fail to the external defibrillation. The defibrillation threshold is much lower than that of the external defibrillation.It helps to develop the implantation of internal atrial defibrillator(IAD).