三维标测系统指导下环肺静脉消融治疗心房颤动

Circumferential pulmonary vein ablation guided by 3 dimensional mapping system for treating atrial fibrillation

目的探讨三维标测系统指导下环肺静脉消融治疗心房颤动的安全性和有效性。方法阵发性心房颤动92例和持续性或永久性心房颤动36例,接受环肺静脉消融术。采用Carto电解剖标测系统,进行环肺静脉左心房线性消融,消融终点为肺静脉电隔离。手术结束时对心律仍为心房颤动者行同步直流电心脏复律。结果完成“解剖学”环形消融线256条,其中58.6%达到电隔离肺静脉的终点,经寻找缝隙补充消融后最终248条(96.9%)消融线达到终点。手术时间(231±45)min、X线曝光时间(42±13)min和放电时间(66±17)min。术后随访平均10个月,无复发101例(78.9%)。接受了再次手术15例,心内电生理检查证实14例有左心房-肺静脉传导,射频消融成功并随访30～270d,两次射频消融术后总成功率为87.5%,其中阵发性心房颤动成功率为93.0%,持续性或永久性心房颤动为76.7%。并发症发生率为6.2%,包括心包填塞2例、小脑梗死2例、股静脉穿刺部位血肿1例和左侧大量血胸1例,经治疗后均痊愈。结论以肺静脉电隔离为目标的环肺静脉消融术治疗心房颤动有效和安全。

Objectives To investigate the safety and efficacy of circumferential pulmonary vein （PV） ablation guided by 3 dimensional mapping system for treatment of atrial fibrillation. Methods Ninety-two patients with paroxysmal atrial fibrillation （AF） and thirty-six with persistent/permanent AF underwent circumferential pulmonary vein ablation. Anatomically guided ablation was performed utilizing the CARTO system and circular mapping catheter to create circumferential lesions around ipsilateral PVs. Afterward, if PV conduction remained, further ablation was performed to isolate the PVs. The endpoint was defined as absence of all PV spikes documented with the circular mapping catheter within the PVs or bidirectional conduction block between left atrium and PVs. Cardioversion was used for the patients with AF at the end of the procedure. Results In the initial procedure, 256 anatomically guided linear lesions around ipsilateral PVs were performed, 150（58.6%） among which achieved the endpoint and the others needed further ablation. Mean procedure time was （231±45） min. Mean fluoroscopy time and radiofrequency energy delivery was （42±13） min and（66±17） rain, respectively. At 10 months follow-up, 101 （78.9%） patients were free of atrial tachyarrhythmias with or without antiarrhythmic drugs. The rate of complication was 4.69%. Fifty patients underwent repeat ablation. Recovered conduction between left atrium and PVs were documented in 93.3% of them. With repeat procedures, the overall success rate was 87.5% （93.0% in paroxysmal AF and 76.7% in persistent/permanent AF） . Conclusions Circumferential pulmonary vein ablation aiming at complete PVs isolation is a feasible and effective approach for treating AF.