经球囊超声消融肺静脉口治疗阵发性心房颤动的临床研究

Clinical study of ultrasound ablation at pulmonary veins orifice in treatment to patients with paroxysmal atrial fibrillation

目的 对经球囊超声消融肺静脉口治疗阵发性心房颤动的疗效和安全性进行临床评价。方法 阵发性心房颤动患者 5例 ,症状明显且应用抗心律失常药物治疗无效。经球囊超声消融肺静脉的开口 ,消融终点为肺静脉电学隔离。结果 总计消融了 19支肺静脉 ,单纯超声消融肺静脉实现电学隔离 15支 (73 .7% )。早期有 1例心房颤动复发 ,1例频发房性期前收缩 ,1例偶发房性期前收缩 ,均经胺碘酮治疗后消失。所有患者的随访时间超过 6个月 ,均可以无需药物而维持窦性心律。并发症包括消融中 1例出现心房穿孔 ,1例出现严重迷走反应 ,无肺静脉狭窄。结论 肺静脉口超声消融是治疗阵发性心房颤动的一种有效手段。

Objective To evaluate the clinical efficacy of circumferential ablation at orifice of pulmonary veins with ultrasound energy in the cure of paroxysmal atrial fibrillation(PAF).Methods The study group included 5 patients with PAF who had significant symptom and were drug resistance,and ultrasound ablation was applied at the orifice of their pulmonary veins to get electrical isolation.Results Nineteen pulmonary veins got electrical isolation and among them 3 were combined with radiofrequency ablation.PAF recurred in one patients and atrial premature beats occurred in other two patients but all disappeared after being treated with amiodarone.During the ablation atrial perforation occurred in one patients and severity vague response in another patient.All patients reached a minimum of six months of follow up,and remained in sinus rhythm.Conclusions The circumferential ablation at orifice of pulmonary veins with ultrasound energy is effective in restoration and maintenance of sinus rhythm in patients with PAF.