盐水灌注导管电隔离肺静脉治疗阵发性房颤

Efficiency and safety of electrical isolation PV with saline irrigated radiofrequency catheter ablation in treating patients with paroxysmal AF

目的探讨盐水灌注导管电隔离肺静脉治疗阵发性心房颤动的有效性和安全性。方法回顾阵发性房颤经盐水灌注导管射频消融电隔离肺静脉治疗的病例,观察其手术情况、近期疗效以及并发症,以评价该方法的有效性和安全性。结果68例发作频繁、药物治疗效果不佳的阵发性房颤患者进行了盐水灌注导管射频消融电隔离肺静脉术,共电学隔离大静脉230根,其中肺静脉208根(左上肺静脉68根、左下肺静脉49根、右上肺静脉49根、右下肺静脉42根),上腔静脉22根。电隔离成功226根,每个患者平均3.4根,即刻隔离成功率为98.3%。平均随访(8.2±3.0)月,(2～12)月,复发6例,3例进行了再次消融术,随访3～6月未见复发;另外3例放弃进一步消融手术;成功率达91.2%。6例复发病例平均在消融术后(8.2±2.8)月复发,但房颤发作频率和症状仍比消融术前轻。术中出现2例急性心包填塞(2.9%),经心包穿刺以及心包引流后好转,1例左上肺轻度气胸(1.5%),胸腔穿刺引流24小时后好转;没有发生肺静脉急性狭窄病例。结论盐水灌注导管消融电隔离肺静脉治疗阵发性房颤是有效和安全的,它是目前治疗阵发性房颤一种很有前途的消融方法。

Objective To study the efficiency and safety of the electrical isolation pulmonary vein （PV） with saline irrigated radiofrequency catheter ablation in treating patients with paroxysmal atrial fibrillation （AF）. Methods Operation information, curative effect and complication of 68 patients with paroxysmal AF who have received the isolation pulmonary vein with saline irrigated radiofrequency catheter ablation treatment were observed to evaluate the efficiency and safety of this method. Results A number of 230 great veins were isolated, 208 were pulmonary veins （left superior PV 68, left inferior PV 49, right superior PV 49, right inferior PV 42 ） and 22 were vena cava. The success number of isolation was 226 with an average number of 3.4 in each patient. The instant success rate was 98.3 %. After a mean follow-up of （ 8.2 ± 3.0） months （2 - 12）months, 6 cases recurred in which 3 cases received reablation and had no recurrence in 3 - 6 months follow-up period, and the other 3 cases refused to have the oulmonarv vein isolation again. The success rate was 91.2%. The mean recurrent time of 6 cases were （8.2 ± 2.8 ） months after pulmonary vein isolation, but the frequency of the paroxysmal AF and the symptoms of the patients improved as compared with that before the ablation. There were 2 cases had acute pericardial tamponade （2.9%） which improved after paracentesis pericardii and pericardial drainage, one case had left upper pneumothorax （ 1.5 % ） which improved after paracentesis pericardii during the electrical isolation. No acute pulmonary vein stenosis happened. Conclusion Electrical isolation of pulmonary vein by saline irrigated radiofrequency catheter ablation is effective and safe for the treatment of patients with paroxysmal AF. It is now a hopeful ablation method for patients with paroxysmal AF.