导管射频消融经验性肺静脉电隔离治疗心房颤动的疗效评价

The Efficacy and Feasibility of Empirical Pulmonary Vein Isolation in Patients With Atrial Fibrillation.

研究导管射频消融经验性肺静脉电隔离治疗心房颤动(简称房颤)的疗效,2001年8月到2003年12月连续收治的131例行射频消融治疗的房颤患者中,107例行经验性肺和/或上腔静脉电隔离。术中只要所标测静脉的肌袖电位明确且与心房之间存在传导关系,以及标测和消融电极导管到位不困难,则行环状电极指导下的节段性消融静脉电隔离。术后不用除β受体阻滞剂以外的抗心律失常药物,临床症状缓解且无房颤的心电图证据判定为手术成功。结果:107例房颤患者中105例即刻静脉电隔离成功(98%),平均每人行3.3±0.8根肺或上腔静脉电隔离,共隔离静脉352根。21例因房颤复发再次行射频消融心脏大静脉电隔离(20%),3例进行了第3次手术,平均每人共完成1.2±0.5次静脉电隔离术。82例(78%,82/105)手术成功的患者随访13±8个月,66例患者无临床症状及房颤复发的证据(80%)。结论:射频消融电隔离3根以上心脏大静脉可以预防约4/5患者房颤的复发,但是部分患者可能需要进行多次手术。

The efficacy and feasibility of empirical pulmonary vein (PV) isolation in patients with atrial fibrillation (AF) were evaluated. Segmental PV and/or superior vena cava (SVC) isolation guided by ostial PV potentials was performed in 107 consecutive patients with symptomatic AF.In those only the arrhythmogenic PVs or SVC were electrically isolated were not included in this study. There were 81 men and 26 women with a mean age of 54±11 years. Results: Segmental PV and/or SVC isolation was successfully performed in 105 patients (98%). Electrical isolation was achieved in 352 cardiac veins and a mean of 3.3±0.8 veins were ablated in each patient. The second electrical isolation procedure was performed in 21 patients (20%) and the third procedure in 3, resulting in a mean of 1.2±0.5 ablation procedures per patient. A close follow up, including Holter monitoring and spiral CT examination, was completed in 82 of the 105 patients (78%) for 13±8 months. Sixty-six patients (80%) were free from recurrent AF without antiarrhythmic drugs except β blockade. Conclusions: With a segmental isolation approach that targets at least 3 PVs and/or SVC, a clinically satisfactory result can be achieved in 80% of patients with AF.