完全肺静脉电隔离在环肺静脉导管射频消融治疗阵发性心房颤动中的意义

The Value of Complete Circular Isolation of the Pulmonary Veins in the Circumferential Radiofrequency Ablation for Patients with Paroxysmal Atrial Fibrillation

目的:评价环肺静脉导管射频消融治疗阵发性心房颤动时以完全肺静脉电隔离作为消融终点的意义。方法:将83例有症状的阵发性房颤患者分为两组,在CARTO指导下,行环肺静脉的线型消融一组(CPVA+Lasso组)43例,消融终点:肺静脉传入、传出阻滞,肺静脉完全电隔离。另一组(CPVA组)40例,消融终点为两侧环肺静脉消融线完整,局部双极电位振幅减低>80%或振幅<0.1 mv;随访3～6个月,对部分药物无效的复发房颤或房速的患者行第2次消融治疗,采用CPVA+Lasso方案。结果:第1次消融结束后,两组患者经过3～6个月随访,CPVA组有24例(60%),CPVA+Lasso组32例(74%),在停服抗心律失常药物后无房颤或房速的发作。对两组中20例药物无效的复发房颤或房速的患者行第2次消融手术,再次消融术中所有患者均采用CPVA+Lasso方案,术后随访3～9个月,停服抗心律失常药物后,症状性房颤或房速不再发作者18例(90%)。结论:环肺静脉导管射频消融治疗有症状的阵发性房颤患者时,以完全肺静脉电隔离为消融终点可有效防止房颤的复发。

Objective：To access the value of complete circular isolation of the pulmonary veins in the circumferential radiofrequency ablation for patients with paroxysmal atrial fibrillation. Methods：Eighty-three patients with symptomatic PAF were divided into CPVA group （n = 40） or CPVA ＋ Lasso group （n = 43）. Circumferential linear ablation around the left and right-sided pulmonary veins guided by 3-dimensional electroanatomic mapping was performed in the two group. In the CVPA ＋ Lasso group, the endpoints of ablation was defined as blocking of all PVs documented with the Lasso catheters by sinus rhythm or coronary sinus pacing. In the CPVA group, the endpoints was defined as circular PV lesions and reduction of the local potential amplitude by 80% or less than 0.1mv. After follow-up of 3-6 months, a repeat ablation was performed after the initial procedure in 20 patients who experienced highly symptomatic atrial fibrillation or atrial tachyarrhythmias unresponsive to anti-arrhythmic drugs with the method of CVPA ＋ Lasso. Results： After the initial procedures, 74 percent of patients in the CVPA ＋ Lasso group and 60 percent of those in the CVPA group were free of recurrent atrial fibrillation or atrial tachyarrhythmia without anti-arrhythmic drug therapy after the first 3-6 months. Repeat procedures were performed in 20 patients with recurrent atrial fibrillation or atrial tachyarrhythmia from the two group with the method of CVPA ＋ Lasso during follow-up of 3-6 months. During the 3-9months after the last procedure, 18 patients （90 %） did not have symptomatic atrial fibrillation or atrial tachyarrhythmia while not taking anti-arrhythmic drugs. Conclusion： The complete circular isolation of the pulmonary veins in the circumferential radiofrequency ablation is effective to reduce the recurrence of paroxysmal atrial fibrillation.