非接触三维标测系统指导下环肺静脉电隔治疗心房颤动的临床评价

Linear ablation and circumferential isolation of pulmonary veins for atrial fibrillation guided by non-contact 3-dimensional mapping system

目的:探讨非接触三维标测系统指导下环肺静脉电融隔离治疗心房颤动(房颤)的可行性和临床疗效。方法:28例药物治疗无效或不能耐受的房颤患者。其中23例阵发性房颤、5例持续性房颤。采用非接触三维标测系统(EnsitenavX)建立左心房、肺静脉的三维等时电势图和电解剖图,并在距离肺静脉口1～2cm处行环肺静脉及其周围组织电隔离。消融终点包括:完成所有环肺静脉消融径线;全部肺静脉均达电隔离;阴性诱发结果。结果:28例患者均达到消融终点;手术的总操作时间和X线曝光时间分别为(161.3±23.2)min和(38.0±6.8)min;随访6～17月,20例(71%)无房颤发作;8例(29%)有房颤复发,其中2例因其发作次数及时间均较术前明显减少未再消融,予以可达龙治疗可控制(术前可达龙治疗无效),6例行第2次消融,术中均发现肺静脉电位有不同程度的恢复,第2次术后4例房颤无再发,2例仍有发作但未再消融,予以可达龙治疗可控制。术中及随访期间无任何操作相关并发症。结论:非接触三维标测系统指导下的环肺静电隔离是治疗房颤的有效而安全的方法。肺静脉既是房颤的诱发机制,亦有可能参与房颤的维持。

Objective To study the feasibility, safety, effectiveness of linear ablation and cir- cumferential isolation of pulmonary veins for atrial fibrillation （ AF ） guided by 3-dimensional mapping system. Methods Twenty-eight consecutive patients with drug refactory paroxysmal and persistent AF were included in this study. Real-time 3-dimensional left artial （LA） and pulmonary veins （PVs） maps were constructed through 3-dimensional mapping system （Ensite NavX） in all patients. Pulmonary vein isolation was performed by encircling the left and right sides of PVs at 1 to 2 cm away from the ostium of PVs. The endpoint of ablation included： All circum PVs ablation lines finished; all PVs were isolated; and non-inducibility of AF was observed. Results All 28 patients reached the endpoint of abalation completely. The mean procedure time and fluoroscopy time was （ 161.3±23.2 ） min and （ 38.0±6.8 ） min, respectively. During the 6 - 17 month follow-up, 20 patients （71% ） were free of AF without any antiarrhythmic drugs. Recurrence of AF was found in the other 8 patients （29%） ： Two were treated with amiodarone and 6 repeated ablation. After the second ablation, 4 were free of AF and 2 recurrence were treated with amiodarone. No complications occurred during the procedure and the follow-up. Conclusion Linear ablation and circumferential isolation of pulmonary veins for atrial fibrillation （AF） guided by 3-dimensional mapping system is effective and safe. But the long-term outcome remains to be investingated.