单导管确定射频消融后肺静脉前庭传导缝隙的初步经验

Preliminary experience of single catheter technique for mapping residual gaps along pulmonary vein an-trum

目的介绍单导管技术确定初始射频消融后肺静脉前庭（pulmonary vein antrum，PVA）传导缝隙的经验。方法对85例抗心律失常药物治疗无效的阵发性心房颤动（房颤）患者进行初始环状消融后，应用单导管技术通过前庭电位的激动标测或根据前庭电位与冠状静脉窦电位的相对关系确定传导缝隙的位置。结果初始环状消融后PVA的电学隔离率：右侧PVA、左侧PVA的隔离率分别为58．8％（50／85），28．2％（24／85），右侧PVA的初始隔离率显著高于左侧PVA（P〈0．001）。右侧PVA消融线有42个缝隙，右侧PVA缝隙的分布前上、前、前下、后上、后、后下分别为8，6，4，9，5，10个。左侧PVA消融线有80个缝隙，左侧PVA缝隙的分布前上、前、前下、后上、后、后下分别为16，35，11，9，4，5个。结论应用单导管消融技术确定射频消融后肺静脉前庭传导缝隙具有可行性。

Objective This study was sought to introduce the preliminary experience of single catheter technique for mapping residual gaps along pulmonary vein antrum （PVA）. Methods After performing initial circumferential lesions in 85 consecutive patients with paroxysmal atrial fibrillation, residual gaps were identi-fied with single ablation catheter guided by activation mapping or electrograms. Results The PVA isolation rate was significantly higher in the right side than in the left side （58.8% vs 28. 2%, P 〈0. 001 ）. Forty-two gaps along the right PVA lesions were identified, of which 8, 6, 4, 9, 5, 10 gaps were in the antero-superior, ante-rior, antero-inferior, postero-superior, posterior, postero-inferior segments, respectively. Eighty gaps along the left PVA lesions were identified, of which 16, 35, 11,9, 4, 5 gaps were in the antero-superior, anterior, an- tero-inferior, postero-superior, posterior, postero-inferior segments, respectively. Conclusion Single ablation catheter technique is feasible in mapping the residual gaps for complete isolation of the PVAs for ablation of paroxysmal atrial fibrillation.