三维电解剖标测及单根环状标测电极指导下CPVA术治疗心房颤动

Application of three-dimensional mapping system and single circular mapping catheter guided circumferential pulmonary vein isolation in the treatment of atrial fibrillation

目的探讨在三维电解剖标测及单根环状标测电极指导下以环肺静脉口电隔离术(CPVA)为核心治疗心房颤动(房颤)的疗效。方法对32例房颤患者均在CARTO三维电解剖标测及单根环状标测电极指导下行CPVA,其中辅助行碎裂电位消融6例,上腔静脉消融术2例,三尖瓣峡部、二尖瓣峡部及冠状窦内消融各1例。结果26例阵发性房颤不再被诱发,6例慢性房颤中术中房颤终止2例、电复律转为窦性心律4例;手术操作时间(119±37)min,X线透视时间(25±12)min;随访(9±5)个月成功率为90.6%。均无手术并发症。结论三维电解剖标测及单根环状标测电极指导下以CPVA为核心,其他消融方法为辅的房颤消融策略安全有效,可提高消融成功率,缩短手术时间,减少并发症、复发。

Objective To investigate the effect of circumferential pulmonary vein ablation（CPVA） guided by threedimensional mapping system （CARTO） and single circular mapping catheter for the treatment of atrial fibrillation （AF）. Methods CPVA were performed in 32 patients with AF, assisted with complex fractionated atrial electrograms （CFAEs） ablation in 6 patients, superior vena cava isolation in 2 patients, mitral, tricuspid isthmus and the coronary sinus catheter ablation in one respectively. Results AF could not induced in 26 paroxysmal AF after ablation. In 6 chronic AF, 2 cases terminated AF during CPVA, sinus rhythm was restored in the other 4 patients by transthoracic cardioversion after the ablation. Mean operation time and X-ray fluoroscopy time were （ 119± 37 ） min and （25 ±12） min separately. The success rate was 90.6% in follow-up of （9 ± 5） months. There were no complications. Conclusion The AFablation with the core of CPVA guided by CARTO and single circular mapping catheter as the core, supplemented by other ablation strategy is safe and effective, which can improve the success rate, shorten the operation time and reduce the complications and recurrence rate.