射频消融治疗心房颤动和心房扑动策略探讨

Ablation for the treatment of atrial fibrillation and atrial flutter

目的评价射频消融使肺静脉电解剖隔离和消除左房碎裂电位治疗心房颤动(简称房颤)的效果,进一步探讨与心房扑动(简称房扑)的关系。方法63例房颤患者分为两组,其中阵发性房颤32例,持续性房颤31例。在Ensite NavX三维标测系统下,建立左心房-肺静脉电解剖模型,分别对左、右肺静脉前庭大环状消融达完全左心房-肺静脉电解剖隔离,若房颤未终止或被诱发,再标测左心房内碎裂电位,消融碎裂电位;对22例合并典型房扑者行三尖瓣峡部消融。随访9个月观察影响手术复发的因素。结果所有患者均达左心房-肺静脉电解剖隔离。32例阵发性房颤患者中23例(71.9%)和31例持续性房颤患者8例(25.8%)经单纯肺静脉电隔离后房颤终止,不被诱发,两者相比有统计学意义(P<0.01);7例(21.8%)阵发性房颤和19例(61.3%)持续性房颤患者经联合消融左心房碎裂电位转复窦律,2例阵发性房颤和4例持续性房颤患者住院期间转复,术中总房颤即刻终止率两组相比较无统计学意义(P>0.05)。阵发性房颤和持续性房颤患者消融成功率分别为84.4%和80.6%(P=0.697),多元Logistic回归分析显示合并典型房扑是房颤术后复发的一个危险因素(P=0.007)。结论肺静脉电解剖隔离结合消除左心房碎裂电位是治疗房颤的一种有效策略,房颤和房扑的启动与维持可能存在一些共同机制。

Objective The aim of this study is to assess whether ablation of circumferential pulmonary vein with complex fractionated atrial electrograms is more effective in patients with atrial fibrillation （AF）, and to explore the relationship of atrial fibrillation and atrial flutter （AFL）. Methods Sixty-three patients with AF were divided into two groups （paroxysmal atrial fibrillation group, n = 32 and persistent atrial fibrillation group, n = 31 ）. All pulmonary veins （PVs）were isolated completely by two circular spectacle-liked radiofrequency ablation lines under the model of atrial and pulmonary vein by Ensite NvaX system. During repeat ablation, complex, fractionated atrial electrograms （CFAEs） were mapped and eliminated providing sinus rhythm still not be maintained. And redo-isthmus ablation were necessary for 22 patients with atrial flutter. Results PVs was isolated in all patients. As compared with the patients in persistent atrial fibrillation group, more patients had not terminated until CFAEs eliminated（ P 〈0.01 ）, and the rates of persistent fibrillation stopped were related to the episode duration （ P 〈 0. 05 ）. The success of Ablation of circumferential pulmonary vein and complex fractionated treating AF and AFL was 84. 4% and 80. 6% respectively （P = 0. 697 ）, By multivariate logistic regression analysis including all the variables evaluated at baseline, the history of APL was only an independent predictor （ P = 0. 007 ） in this model. Conclusions Ablation of circumferential pulmonary vein with complex fractionated atrial electrograms is more effective in patients with atrial fibrillation, and the trigger and maintaining between AF and AFL may have some common mechanism.