单纯碎裂电位指导心房颤动消融的初步临床观察

Clinical evaluation of radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms

目的探讨碎裂电位指导心房颤动（房颤）射频导管消融的可行性。方法22例药物治疗无效有症状的房颤患者（阵发性16例，持续性6例），在自发或诱发房颤时，用Carto构建左心房或左、右心房的三维模型并标测、消融碎裂电位，终点是消除标测到所有碎裂电位或转复窦性心律。结果碎裂电位消融后，13例（59％）转复为窦性心律（直接转复7例，先转为房性心动过速（房速）／心房扑动（房扑）然后转复6例），9例消融未转复窦性心律患者行电复律或药物复律成功。6例复发（5例房速／房扑，1例阵发性房颤）再次消融，5例成功，随访3—18（10．9±4．8）个月，共有16例（73％）无快速房性心律失常事件，碎裂电位主要分布于左侧房间隔、肺静脉周围、左心房顶部。碎裂电位消融后房颤终止前房颤周期与碎裂电位消融前相比明显延长[（157±18）ms vs （211±32）ms，P〈0．05]。除一例发生心脏压塞且心包穿刺成功引流外，无消融术相关的并发症和后遗症。结论碎裂电位指导房颤导管射频消融安全有效可行。

Objective To evaluate the feasibility of radiofrequency catheter ablation of atrial fibrillation （AF） guided by complex fractionated atrial eleetrograms （CFAEs）. Methods Twenty-two patients with drug refractory, and symptomatic AF（ 16 paroxysmal, 6 persisten） were enrolled. Using Carto, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identified. Radiofrequency ablation at the site with CFAEs was performed and the end points were to eliminate CFAEs or convert to sinus rhythm. Results Thirteen patients（59% ）were converted to sinus rhythm, （7 cases converted directly to sinus rhythm, and 6 via the intermediate atrial taehyeardia（AT） or atrial flutter （AFL）. The remaining nine patients required cardioversion with D. C. shock or drug. Repeat ablation was performed in 6 patients （5 AT/AFL, 1 paroxysmal AF）. During（10. 9 ±4. 8） months follow-up, 16 patients （73%） were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, left atrial roof. CFAEs ablation prolonged AFCL[ （ 157 ± 18 ）ms vs （211 ± 32） ms, P 〈 0. 05 ]. Only one patient had pericardial tamponade that required perieardiocentesis. Conclusion Radiofrequeney eatheter ablation of atrial fibrillation （AF） guided by CFAEs is safe and effective.