导管消融治疗心房颤动的有效性与安全性研究

Result of Catheter Ablation in 36 Paitents of Atrial Fibrillation

目的探讨经导管消融治疗心房颤动的有效性和安全性。方法对32例阵发性房颤,4例持续性房颤患者进行导管消融治疗。其中,3例患者采用环状冷冻导管消融(cryoablation)隔离肺静脉;33例患者采用Lasso导管及三维电解剖标测(CARTO)指导的环肺静脉前庭线性消融。结果成功率:冷冻消融组为33.33%;CARTO组为90.9%。手术时间:CARTO组较冷冻消融组,手术时间延长,CARTO组手术时间为(325±79)min;冷冻消融(205±72)min,P<0.05。X线曝光时间:CARTO组较冷冻消融组,曝光时间缩短,CARTO组(43±16)min;冷冻消融为(55±18)min,P<0.05。并发症:冷冻消融无并发症;CARTO组出现2例心脏压塞;另有1例患者术后第2d出现脑栓塞,经药物治疗后,肢体障碍完全恢复。结论经导管冷冻消融及CARTO指导下,环肺静脉前庭线性消融治疗房颤的方法均安全有效。三维电解剖标测(CARTO)指导下的环肺静脉前庭线性消融术效果更好。

Objective To evaluate the efficacy and safety of the treatment of atrial fibrillation （AF） by catheter ablation （CA）. Methods CA was applied in 36 patients. Among them, 32 patients were drugrefractory paroxysmal AF, and others were persistent AF. Two different methods were performed to disconnect the electrical activity of pulmonary vein （PV）. 33 patients （three with persistent AF） underwent circumferential pulmonary vein linear ablation guided by 3 - D mapping system （CARTO system） and three patients （one with persistent AF） underwent PV isolation by cryoablation. Results Successful rate： It was 33.33% in group of cryoablation and 90.9% in group of circumferential pulmonary vein linear ablation guided by CARTO system. Procedure time It took （205 ± 72） minutes in group of cryoablation and （325 ± 79） minutes in group of circumferential pulmonary vein linear ablation guided by CARTO system. P 〈 0.05. X - ray exposure time： It took （43 ± 16） minutes to adopt circumferential pulmonary vein linear ablation guided by CARTO system and （55 ± 18）minutes in group cryoablation. P 〈 0.05. Complications： There was no complication in group cryoablation. Two patients had cardiac tamponade during ablation in CARTO group. One patient had stroke next day of the operation in group of circumferential pulmonary vein linear ablation guided by CARTO system and he recovered well by medicine treatment. There was no death case. Conclusion It might be effective and safe for patients with atrial fibrillation to adopt circumferential pulmonary vein linear ablation guided by CARTO system and cryoablation.