阵发性心房颤动的射频导管消融大静脉电隔离治疗

Electrical isolation of big veins by radiofrequency catheter ablation for the treatment of paroxysmal atrial fibrillation

目的报道阵发性心房颤动(房颤)的射频导管消融电隔离肺静脉和腔静脉的疗效.方法阵发性房颤患者36例,年龄(42.5±13.2)岁.经1次房间隔穿刺放置环状标测电极导管(Lasso导管)和冷盐水灌注消融导管,在Lasso导管的指导下,采用全肺静脉或上腔静脉与靶静脉节段性电隔离相结合的方法对肺静脉和腔静脉行标测和电隔离治疗.窦性心律时最早激动的肺静脉和腔静脉电位处和/或心房起搏时最短的心房和静脉电位间期处为靶点行消融.结果 36例阵发性房颤患者均接受一次电隔离治疗,共电隔离大静脉115根,其中左上肺静脉34根,左下肺静脉22根,右上肺静脉30根,右下肺静脉17根,上腔静脉12根,即刻电隔离成功率为95.6%,术中并发症发生率2.78%.随访3～22个月,成功率(无房颤发作或房颤发作明显减少)为75.0%.结论射频导管消融电隔离肺静脉或腔静脉与心房间的电活动连接,可有效预防房颤的复发.治疗的关键是消融靶点的标测和确定.

Objective The purpose of this study was to assess the methods and effects of radiofrequency catheter ablation （RFCA） on paroxysmal atrial fibrillation （PAF）. Methods Thirty-six patients [ male 24, famale 12, mean age （42. 5 ± 13.2） years ] with PAF underwent RFCA. All patients underwent routine electrophysiological study, adopted one transseptal procedure, and Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium or superior vena cava. The earliest activation potential of pulmonary vein or caval vein during sinus rhythm and/or the shortest period between left or right atrium and pulmonary or caval vein potential during atrial pacing were the target point for ablation. Results Thirty-six patients with PAF were performed with RFCA. A total of 115 pulmonary or caval viens were ablated, including 34 left superior pulmonary veins ,30 right superior pulmonary veins ,22 left inferior pulmonary veins, 17 right inferior pulmonary veins and 12 superior caval viens. Successful electrical isolation was obtained at the end of ablation procedure in 110 veins（ 95.6% ）, during follow-up of 3 to 22 months ,27 patients（ 75.0% ） were remained free of PAF or less recurrence without medication. Conclusion 95.6% big veins of the heart can be electrically disconnected from atria by RFCA in patients with PAF,the success rate is relatively high.