环肺静脉线性消融治疗慢性心房颤动疗效分析

Pulmonary vein antrum isolation guided by 3-D mapping system in 100 patients with chronic atrial fibrillation

目的探讨三维标测系统指导下环肺静脉线性消融治疗慢性心房颤动(房颤)的疗效和安全性。方法2004年8月至2005年11月间对连续100例慢性房颤患者进行三维标测系统(CARTO系统或EnSiteNavXTM系统)指导下的环肺静脉线性消融,消融的主要终点为肺静脉电学隔离。随访成功的定义为未服用抗心律失常药物无任何房性心律失常发作至少3个月以上。统计相关变量,分析影响成功率的因素。结果平均随访9·7±5·7个月,累计成功率为70%(70例)。复发患者中峡部消融比例及平均射血分数均低于无房颤复发的患者。主要并发症包括心脏压塞3例(3%)、脑卒中1例(1%)、无症状性肺静脉狭窄2例(2%)。结论三维标测系统指导下环肺静脉线性消融治疗慢性房颤疗效较好,安全性有待进一步提高。

Objective To investigate the efficacy and safety of circumferential pulmonary vein （PV） linear ablation （CPVA）guided by 3-D mapping system in patients with chronic atrial fibrillation （CAF）. Methods From August 2004 to November 2005, 100 consecutive patients with CAF were admitted to undergo CPVA guided by CARTO system and EnSite NavX^TM system, the main procedure end point is electrical isolation of PVs. Success was defined as atrial tachyarrhythmia free without any antiarrhythmia drugs for at least 3 months. Clinical and procedural variables were collected, ANOVA analysis was employed to identify the risk factors predicting recurrence, P 〈 O. 05 was considered significant. Results After a mean of 9. 7 ± 5.7 months follow up, 70% （70/100） of patients freed from AF. ANOVA analysis identified isthmus ablation and poor left ventricular ejection fraction as the independent factors predicting success. Complications including pericardial tamponade （3 cases, 3% ）, stroke （1 case, 1% ）, asymptomatic pulmonary vein stenosis （2 cases, 2% ）. Conclusion CPVA guided by 3-D mapping system can be performed in CAF patients with an acceptable efficacy, but safety need to be improved.