环状电极在Ensite/NavX指导下的心房颤动环肺静脉消融术中的应用

The application of circular mapping during circumferential pulmonary vein ablation (CPVA) for atrial fibrillation guided by Ensite/NavX system

目的评价环肺静脉消融术联合应用环状电极标测对心房颤动(房颤)消融成功率的影响。方法连续入选61例房颤患者,其中男40例,女21例,阵发性房颤50例,慢性房颤11例。在EnsiteNavX三维电解剖标测系统指导下行环肺静脉消融术。应用环状电极标测肺静脉电位,以肺静脉电隔离为消融终点。结果61例均顺利完成手术。环左肺静脉消融使左肺静脉电隔离34例(55.7%),环右肺静脉消融使右肺静脉电隔离35例(57.4%),环左、右肺静脉消融使所有肺静脉电隔离23例(37.7%)。16例阵发性房颤和5例慢性房颤放电时终止房颤,终止房颤部位为左、右上肺静脉外近房顶前、后壁19例,右上肺静脉外后壁中部1例,完成左肺静脉消融时房颤终止1例。平均随访6±2个月,50例阵发性房颤中42例(84.0%)以及11例慢性房颤中5例(45.4%)无房颤发作,总成功率为77%。并发症:少量心包积液1例,经心包穿刺引流后积液消失;左侧血胸1例,经胸腔穿刺引流痊愈。结论EnsiteNavX系统指导下的环肺静脉消融术中联合应用环状电极标测可使房颤消融成功率进一步提高。

Objective The Application of Circular Mapping during Circumferential Pulmonary Vein Ablation （CPVA） for Atrial Fibrillation Guided by Ensite/NavX System. Methods To evaluate the effect of combined circular mapping on the success rate of CPVA. 61 consecutive cases （40 males and 21 females） were included in the study. 50 cases with paroxysmal atrial fibrillation （PAF） and 11 cases with chronic atrial fibrillation （CAF） underwent CPVA guided by the Ensite/NavX system. A circular electrode catheter was used to map the pulmonary vein （PV） potentials. Pulmonary vein isolation was taken as the endpoint for ablation. Results MI the 61 cases underwent the procedure successfully. LPVs were isolated in 34 cases and 35 cases underwent single RPVs isolation. Circumferential ablation of both LPVs and RPVs were carried out in 23 cases. Atrial fibrillation was terminated when delivering radiofrequency energy in 16 cases with PAF and 5 cases with CAF. The termination sites were located near the anterior or posterior roof of the superior PVs in 19 cases and at the mid-portion of the posterior wall from RSPV in 1 case. Atrial fibrillation was terminated when after comple to LPV ablation in 1 case. During the follow-up of 6± 2 months, 42 PAF cases and 5 of 11 CAF cases were atrial fibrillation free. The total success rate was 77 %. Complications： Pericardium effusion was found in 1 case and disappeared after pericardium puncture, and drainage. 1 case developed hemothorax and was cured after thorax puncture and drainage. Conclusion The application of circular mapping during circumferential pulmonary vein ablation guided by Ensite/ NavX System contributes to improve the success rate of atrial fibrillation ablation.