环肺静脉电隔离术中自发电位传出导致的房性心律失常的再次消融及其评价

Ablation and evaluation of atrial arrhythmias induced by spontaneous pulmonary vein potentials during circumferential pulmonary vein isolation

目的分析心房颤动（房颤）环肺静脉电隔离术中出现肺静脉自发电位传出导致房性心律失常的发生及其再次消融评价。方法在三维标测系统指导下行环肺静脉电隔离及辅助线、碎裂电位等消融治疗房颤，术中观察分析导致房性心律失常的肺静脉自发电位，对靶肺静脉行补充消融达完全电隔离并对其再评价。结果术中5根肺静脉出现自发电位，但证实肺静脉与心房之间为单向阻滞，仔细观察分析对靶肺静脉进行再次消融均达到完全电隔离且再无肺静脉相关性房性心律失常。结论环肺静脉电隔离中肺静脉内出现自发电位仅说明心房至肺静脉的传导阻滞，仍可存在肺静脉内自发电位传出导致房性心律失常，术中需仔细分析鉴别并对靶静脉消融隔离以减少术后房性心律失常发生。

Objective The atrial arrhythmias （AAs） induced by spontaneous pulmonary vein potentials （SPVPs）in patients with atrial fibrillation undergoing radiofrequency catheter ablation（RFCA） were identi-fied and ablated. Methods The RFCA combined with circumferential pulmonary vein（PV） ablation and linear and/or complex fractionated atrial electrograms ablation were performed under the guidance of three-dimension mapping system. During operation, the SPVPs which induced AAs were identified, and then gap ablations were performed to completely isolate the target PVs, after that bidirectional block between PV and atrium were identi- fied and evaluated. Results The unidirectional block between PV and atrium which indicated by the SPVPs efferent to atrium and induced AAs were confirmed in five PVs. The breakthrough points from PV to atrium were discriminated and ablated, and all target PVs were isolated completely which cannot induce AAs. Conclusion The SPVPs after RFCA just indicates the unidirectional block between PVs and atrium, which manifestes the block from atrium to PVs, may efferent and induce AAs. So it is important to identify the unidi- rectional block and to isolate the target PVs to reduce AAs after RFCA.